The Magic Bullet (39 page)

“I love these stories,” she said.

“Hearing them’s a lot more fun than living them,” he assured her. “We’re dealing here with
lunatics
.”

She snuggled even closer. “Soon it will be light. We should get some sleep.”

“Sabrina …”

“Yes.”

He’d been avoiding the subject all night. “Has anyone said anything to you? About Mrs. Dietz?”

It was possible no one had. As the least combative member of the Compound J team, Sabrina was generally spared the hostility that came Logan’s way as a matter of course.

She paused before answering. “Allen Atlas.”

“Oh, Christ. What?”

“He was
happy
at the news. Making jokes. He said to me, ‘So, this is one of your success stories?’ ”

“I love these guys. They don’t mind being known as vicious bastards as long as they’re not hypocrites!”

“In Italian we have an expression,
‘lupo affamato.’
A hungry wolf.”

In the dark, Logan nodded grimly. “It’s almost the same in English—‘licking his chops.’ ”

Three days later, just past noon, Logan got the call from a Dr. Edward Reed of Holy Name Hospital in Dover, Delaware. Sharon Williams had just been admitted to his care.

“I understand she’s part of a protocol you’re running there.”

“Yes, that’s right,” said Logan, in his best noncommittal voice.

Sharon Williams! Incomplete as the supporting evidence remained, Logan considered her response against tumor in the bone the protocol’s most startling achievement yet!

“What seems to be the problem?”

“Her husband brought her in just a little while ago. I’m afraid she’s decompensating.”

“Could you be more specific?”

“Apparently, she was at home when she began complaining about not feeling well. By the time she got here she was already becoming encephalopathic. We’ve got her in the intensive care unit.”

Oh
,
Christ. Another liver failure!

“I don’t suppose there’s any chance you could put her in an ambulance and get her over here?” From Dover, the trip would be little more than an hour—with no expenses that had to be okayed.

“I don’t think that’s a good idea. This woman is really too unstable to be moved.”

“No, you’re probably right,” he paused. “I hope you won’t mind if I come to you.”

Holy Name Hospital featured little of the super-high-tech equipment that by now Logan had come to take for granted, but he quickly noted the place was modern and efficiently run. By community hospital standards, a superior facility.

To facilitate observation, Mrs. Williams’s bed was in a room enclosed on three sides by clear glass. A monitor above her registered an EKG reading of 160 and showed her blood pressure at eighty-five over fifty. At her side heaved a ventilator, helping to keep her lungs going. A Swan-Ganz catheter had been threaded through her subclavian vein, through the heart and the pulmonary artery directly into the lung, where it was recording pulmonary capillary pressure.

Literally within seconds, Logan knew all he needed to know. Sharon Williams was dying.

“Dr. Logan?” He turned to face a smallish young man with white-blond hair and a face so young, he might have been a teenager. “Ed Reed.”

They shook hands.

“It’s painful to see,” said Logan softly. “I saw her less than a week ago.…”

“We did some blood work on her. Would you like to see the results?”

“Tell me.”

“It’s not pretty. Her hepatic transaminases”—enzymes measuring liver function—“are completely out of sight.”

“Do you have her on fentanyl?” The drug in question, a
highly potent anesthetic, is often used with patients who are obliged to spend prolonged periods immobile.

“There doesn’t seem much point, she’s not aware anyway.”

“No.” Logan sighed. “Look, thanks for putting up with me. I know it’s not easy having a stranger hanging around.”

The other smiled broadly. “My pleasure, really. I’m a big fan of you people at the ACF.”

If only you knew, kid, if only you knew
. “Thanks. Do you maybe have a library here, somewhere I can kill some time?”

“You’re going to wait it out?”

“I’d like to.”

Reed pointed down a hallway. “Take the stairs down and then a left through the waiting room. It’s not much after what you’re used to.”

“Actually, I’ve been so busy lately, I wouldn’t mind just catching up with the basic journals.”

He was following Reed’s directions, heading through the waiting room, when he spotted a large black man, sitting beside a girl of seven or eight. Or, more precisely, they simultaneously spotted one another. It took Logan a moment for the face to register: Sharon Williams’s husband. They’d met only once before, at the ACF, the day his wife came in for her first treatment.

He stopped and turned. But already Simon Williams was on his feet, coming his way.

“Mr. Williams,” said Logan, extending his hand. “Dan Logan, from the American Cancer Foundation.” Up close, he saw the strain Williams was under in his eyes.

“I know who you are,” he said softly. Slowly, with seeming reluctance, he shook the doctor’s hand.

“I got here as soon as I heard about Sharon.”

“Yes.”

“She’s a strong person. We’re all hoping for the best.”

He was sorry as soon as the words were out of his mouth. There are people who want to be bullshitted, but
this man already knew the truth. He fixed Logan with a hard stare.

“I have just one question.”

“Yes.”

“I read that consent form of yours. It didn’t say anything about something like this.”

“Mr. Williams, I’m sorry. We truly had no way of knowing.”

“See that little girl over there?” He indicated his daughter. “Why don’t you tell that to her? Or to her three-year-old sister?”

To this, Logan made no reply. It was an uncharitable thought, but given Logan’s state of mind, it arose all the same: Would this guy be complaining if, as it had seemed such a short time before, the drug’s effects had been beneficial? Yes, he understood the man’s distress, even his anger. But doctors are also human—and medicine is imperfect.

“I’m deeply, deeply sorry you and your family have to go through this,” he said blandly, just wanting to get the hell out of there. “No one should have to. I only hope you understand that we’ve done the very best we know how.…”

He spent the next several hours in the library—actually, no more than a normal patient room outfitted with shelves and a couple of chairs as a reading room—catching up on the
New England Journal of Medicine
and the
Annals of Modern Medicine
. But he read distractedly, frequently lapsing into troubled daydreaming. What he needed to know would never turn up in any journal. How could a drug that showed such tantalizing promise simultaneously be so brutally destructive? And why did the deadly side effects appear to be so pronounced in the very patients it at first seemed most to benefit?

It was early evening when Logan heard the footsteps in the deserted hall and Reed appeared in the doorway.

“She’s gone,” he said. “Just a few minutes ago.”

Logan rose to his feet. “Well … thanks for letting me know.”

“There was nothing we could do. She never had a chance.”

“I know that.” He glanced at his watch. “I guess I should be heading home.”

“Hey, look. If you’re up for it, maybe we could grab some dinner.”

Caught off guard by the sudden shift in the young doctor’s tone, Logan looked at him quizzically. Reed was smiling. “Maybe it’s not the best time,” he added in explanation, “but I thought maybe you could give me some tips on how I could hook up with the ACF.”

Logan could only smile wearily. “Actually, based on what I’ve seen, you’d probably do very well there.”

When Sabrina opened her front door, Logan knew she had some bad news of her own.

“What is it, Sabrina? What’s wrong.”

“There was a call a while ago. From Pennsylvania. Mrs. Rhome died today.”

He hardly reacted at all—the same way she took his news from Delaware. Whether by training or instinct, they pressed on.

There was, after all, something vital upon which to focus. If Compound J was killing the very women whose cancer it destroyed, there still remained one such woman unaccounted for.

When there was no answer at Mrs. Kober’s home, Logan suspected the worst.

“Relax, Logan,” said Sabrina, though she was thinking the same thing. “Probably she’s just not at home. We would surely hear something otherwise.”

“At ten o’clock at night? Where would she be?”

“You left a message. When she gets it, she will call.”

But when they didn’t hear from her, both spent a fitful night; and it was Sabrina who awoke early—before six o’clock—to call again.

“Listen,” she repeated, with diminished conviction, “if she’s in a hospital, someone would call us. There is no doubt.”

“If they knew they should.”

“This is what happened with Mrs. Williams and Mrs. Rhome.”

“Both of them had family. Mrs. Kober is alone.”

T
hinking back on it later, Logan was most amazed by not how quickly their support melted away, but how unembarrassed some of his co-workers were by their own behavior. But that morning, arriving at the ACF, there it was. He was a pariah.

Individuals who after the Grand Rounds presentation, barely a week before, had embraced him as a close friend and colleague, now hurried by stonefaced. More than simple slights, these were willful acts of negation, meant to instantly dispel any illusion Logan might have that there existed a relationship between them.

Logan knew he shouldn’t be surprised.
After fifteen months at this place? What the hell’s wrong with me?
But he was, more than he let on.

That afternoon he found the note in his box. He would learn it was identical to the ones Sabrina and Reston found in theirs. Written on the stationery of the director of the Medical Branch, it was vintage Larsen; devious even as it seemed to come right to the point:

Logan noticed that Larsen had signed his name with an unusually zestful flourish.

* * *

At least the timing was a blessing. As most experienced doctors know, human nature tends toward the morbid; in desperate circumstances, almost anyone with enough time to fret about the possibilities starts dwelling on the worst. More than once, Logan had himself seen patients in for serious surgery, at first upbeat about their chances, then increasingly drained of spirit when the procedure had to be delayed.

Now, with the meeting barely twenty-four hours off, they had far too much to do to let their imaginations run wild. There were patient records to comb through, autopsy findings to be reexamined, a defense of the protocol to be prepared.

After all, reality was more than bad enough. Larsen clearly intended to rake them over the coals; and probably, finally, if he could find a way to circumvent normal procedures, try to shut down the Compound J trial by executive fiat.

Beyond that?

Realistically, what
could
he do? Ten months remained on the two-year contracts they had signed as incoming junior associates. And, in any case, despite everything, who could deny their promise as oncological researchers? Even at the ACF, vindictiveness had its limits. The likeliest scenario was a stem reprimand, a PR move designed to ward off potential embarrassment. Patients on this trial were dying. If the press got wind of it, the ACF had to be seen as having taken some action.

At any rate, this is how Logan evaluated things. Even Sabrina, the ultimate pragmatist, chose to see the positive aspects of what was obviously to be a painful encounter. They would take their shots, but at least there was to be a dialogue; a chance, after all the simmering hostility and silent undercutting, for them to make their case.

And as they worked on it in the library that day and into the evening, that case seemed to them eminently defensible. Yes, of course there had been setbacks, major
ones. They were more heartsick about the Compound J–related deaths than anyone. They’d come to know these women, in a couple of cases to admire them deeply.