by Kate Ledger
It was not an easy therapy. The shining, beveled edge of the needle dove into the meat of Jim Weaver’s shoulder. Jim cried out, the stump writhing, as Simon plunged the saline solution into the blind-looking inversion of skin where the arm ended. Jim’s lips pursed in acceptance of the pain, his eyes rolled back and then blinked wetly as he was unable to hold back the sound, “Ohhhwwhh!”
“You get a sharp pricking pain from the hypotonic solution, but it should counter some of the sensation in your arm,” Simon explained, fighting against his own surge of nausea.
“I’m trying to keep it quiet,” Jim Weaver apologized, with his one hand wiping the wetness that smeared his cheeks. “Oh. It’s terrible.” He sat hunched on the exam table, his eyes closed as if he were praying. “Ohww.”
“Hope this does it,” Simon said, jaw tight.
“Me too. Thank you. For trying.” Jim’s eyes filled with tears again. He said, whispering, “For taking me seriously.”
Simon gave Jim a quick, soft squeeze on the good arm. “Keep me posted,” he said, and left the room.
When he met with Julie in the hallway, she was leaning against the cabinet, scraping a spoon across the top of a cup of yogurt that was apparently frozen. Her pose was insolent and the sound of the scraping was punishing, a rake across pebbles.
He refused to look at her as he busied himself filling out an information sheet for Jim’s folder. “You should get more experience before you go about formulating such strong opinions,” he chastised. “You should wait and see. You’ll be surprised what you learn.”
She answered with a scrappy, scratchy noise, like the ripping of Velcro, stuttering the spoon across the surface of her yogurt.
“Is that lunch?” he asked with disgust, watching her shave channels through the yogurt.
She gave another coy scrape of the spoon. “I found your drug,” she answered. “I called Boeker Pharmaceuticals. Sulmenamine is one of their drugs that’s currently in Phase II trials. It’s not available otherwise.”
“It’s currently being tested? For what?”
She stopped eating to push a scrap of paper across the counter with a single finger. “Here’s their number, if you want more information.” It was at that moment he realized he’d made a mistake. She was unkind and unfeeling, she had no internal sense of patients, no compass in her gut to make her understand them or why you sometimes had to put yourself on the line for them, and she probably had an eating disorder, he thought, as he watched the icy excavation she was performing on her so-called lunch. Oh, why had he kissed her? The blunder of all blunders. Now, if he fired her, she’d point to the kiss and say he was punishing her because she had turned him down. It had been a silly little outburst, a moment of emotion. She just happened to have been standing there.
In his mind, Emily’s face chastised, and he wished he’d never seen Julie McKinley, that she’d never come into his office and that he’d never felt compelled to help her advance her career. She didn’t like him, and she never would understand him. He picked up the number and, without another word to her, disappeared into his office. He closed the door and called the drug company.
The Boeker operator’s voice, middle-aged, tired and unsmiling, made him instantly officious. “I’m a physician,” he informed her.
“Are you participating in one of our trials?” she wanted to know.
“No. I’m looking for information.”
“The sulmenamine trial is the one that’s still open. Passed Phase I toxicity tests. Now, in Phase II, we’re testing to see if the drug works. Next they’ll do the Phase III double-blind placebo-controlled studies for efficacy. I can give you a phone number and you can listen to the prerecorded information.”
So his father was involved in a drug test? Simon knew of physicians who were involved in conducting tests for pharm companies. He’d met a guy one time when he’d been on vacation with Emily in Colorado, Phil something, who’d been at the bar in the Regency Hotel as they both waited for their wives. He was good-looking, an internist with slicked hair, as if he were bringing back the old-school Vitalis sheen. Ekham Drugs, one of the big companies, was paying him to recruit patients for a study. He didn’t even have to conduct the study, he bragged to Simon. All he had to do was refer patients along to the participating physicians and he was rewarded with a finder’s fee. Like a guy with a used car he had to unload, he was telling everyone he could about the drug, a new asthma inhalant.
“I don’t want a prerecorded message,” he informed the operator. “I want to know about the drug. What’s it for? What class is it?”
The Boeker operator said, “Let’s see here.” She sounded as though she were checking a chart. “Um-hm. Yes. That one is being tested for sexual dysfunction.”
“No,” Simon corrected her. “It’s a drug for syncope.”
“That’s not what the trial is, though,” she said. “It’s for, you know, performance. Do you want me to read it to you?”
He snorted. “You must be making some kind of mistake,” he insisted.
“I’m looking right at the information, sir,” she stated. “It’s right here in front of me.”
“Okay,” he said slowly, deciding on a different tack. “How do I find out about the trials? What if I want to participate?”
“Where are you calling from?”
“Baltimore. I’m an internist. Private practice. Big practice.” There was a pause. “I was named one of Baltimore Magazine’s Top Docs,” he added.
“We can have a rep come to you with a presentation. Greg’s in charge of recruitment in the Mid-Atlantic. He can tell you about the drug and describe the study.”
“How soon?”
“Next Friday?” she proposed.
“No sooner?”
“I have to let you know,” she said, in a voice that would have offended him if he hadn’t had other concerns, “that we’re no longer offering incentives for recruiting patients.”
“I don’t want any money,” Simon said quickly.
This response seemed to satisfy her. “Our rep Greg will be happy to come out for the presentation.”
So his father had entered a trial for sexual dysfunction. He was relieved he hadn’t told Emily. She’d probably say it was just another reason to stay out of Charles’s business.
Of course, she would say, couldn’t Simon see now why Charles had been so secretive in the first place? What business was it of theirs if Charles was trying to recapture his youth? Who wouldn’t be afraid of dying, if not the old, when death was the next train station and the conductor was about to make the call? But Simon would have to protest: Maybe Charles had been recruited for the study of sulmenamine by some crank doctor, someone like the Vitalis-headed, used-car salesman Phil. Someone had pitched him the idea to participate in a trial, and Charles had agreed because he didn’t know any better, because for all his skepticism and his talk-radio expertise about the world, when it came to health, he was really as gullible as an immigrant stepping off a boat, ready to hand over a life’s savings for gum wrappers. Now he was giving himself injections of some unknown compound, some outdated, uninvestigated pharmaceutical from an ancient formulary. It was further proof the man needed a chaperone through his medical care: He needed Simon’s help. What use does a man in his seventies have for a drug to give him a four-hour erection? He felt hatred for the doctor—a snake, no doubt—who had signed Charles up for a trial.
“Isn’t that conflict of interest?” Simon had asked when Phil told him that he knew doctors who were going to make an extra half million just for signing patients up.
Phil must have already grappled with this. Or he’d already been fed a line. “How else do drugs get into the pipeline?” he argued. “Companies need patients, we got access.”
When Simon hung up with Boeker, he dialed his parents’ number. Lucille answered. Simon meant to sound breezy. He meant to sound like he was just calling to check in, but his voice brayed, the questions like karate chops. “What’s the
news? What do they say? How’s he doing?”
“The same,” she answered, sounding cheery. “Nothing to report.”
He took a breath. “I know what that drug is, Mom,” he said. “The one he was hiding away. It’s being tested, did you know?” She said nothing. “Who signed him up for that? Did you know what he was getting into? Nobody knows anything about that stuff.”
He waited, and he could see her stiff expression as she sat in silence. Then he heard the sound of a door closing. She lowered her voice, “It’s his business, Simon. I’ll thank you to stay out of it.”
“Trust me, I don’t want any part of it. Please,” he groaned, “don’t give me any details. But I have to know one thing. Did someone talk him into being part of a trial?”
She was quiet for a moment, and he knew that he’d hit on something. “I wondered about that, too. When he first brought it home, I thought, Now, what’s this? It didn’t have any effect that was noticeable, at least as far as the trial went—”
Simon closed his eyes. “Okay, already too much information. I don’t want to know—”
She ignored his protest. “—but he did notice the medication made him feel better.”
“What do you mean ‘better’?” he demanded.
“His arthritis, for one. That felt better. Just his sense of things, better. I don’t know, just better. So he kept it. When he ran out, he got more from the doctor. He doesn’t need to take it that often, but it’s really helped. His arthritis has been significantly better.”
Simon struggled to put the pieces together, but then it began to make sense. “Is that why he felt fine after the accident? Was he taking it then?”
Her voice became light and aloof-sounding again. “I don’t know why he felt what he did,” she said. “All I know’s what he said.”
“I don’t get it,” he said. “Does anybody know he’s still taking it? Is anybody supervising him?”
He wanted to ask Charles directly, but he remembered a moment in high school, a science project about weather, when he’d convinced pasty, encyclopedic Bruce Andrews that it would be possible to build a rain machine. Simon drew up the plans, which he insisted would require only a tank, a compression pump and a small generator. The night before the project was due, Bruce stayed over and the two of them worked all night, but all they’d managed was condensation on the walls of the tank. Bruce chewed pencils, then broke them in half, then kicked objects in Simon’s bedroom, then cried when it was clear that the project was screwed.
Bruce sulked in his sleeping bag on Simon’s floor until he eventually fell asleep, but Simon stayed up, writing by hand a rambling, very emphatic five pages of what the machine should have done—part technical explanation about what was wrong with the contraption, part scientific treatise about the difficulties of reproducing global phenomena, part diatribe for having too little time to build a real machine—and handed it in. The teacher gave them an A for concept, since they’d dared to undertake such an imaginative project, and an A for execution, not for the construction of the rain machine, but for not having backed out of a technical and intellectual challenge in order to whip together something simpler for a grade. Bruce, who cared only about grades, couldn’t have been more astounded by their good fortune if they’d whipped up a tidal wave. But Simon had felt a righteousness about his effort, and indignant about what was possible given the confines of the assignment, and he accepted the grade as if it were a jacket sewn specially for him.
But that night, as he’d recounted the success, Charles had looked at him with no expression. “Let me get this,” he’d said. “They’re giving As these days for not completing science projects?”
“I thought up the whole thing,” Simon responded. “It was my idea.”
“It failed.”
Simon shrugged. “I told her what happened.”
“Thinking of something isn’t the same as doing it. It isn’t even the same as having the know-how to improvise. Know what that is in the real world? That right there’s an A for going down with your ship. That’s an A for being dead in the water.”
No, he did not want to hear what Charles thought about the drug. He wanted information but he wasn’t going to beg for it.
Then he heard a noise in the background, beyond Lucille’s voice, and he was certain she was no longer alone. “It’s not yours to worry about,” she said quickly. “And that’s all I can say.” She was off the phone before he could inquire anything more.
Greg the drug rep appeared the following Friday. He wore a blue oxford and a tie that was lustrous purple, a color too flashy and too confident for a trustworthy man to use as business attire. Simon was accustomed to the reps, usually women, who were always overdressed, like stewardesses with evangelical intensity. Their manners were too smooth, their hair too perfect. You could smell how much they liked money. Greg’s slacks were narrow, the crease down the front razor-thin. His combed hair appeared molded to his head like one of Jamie’s old Ken dolls, from back in the day when she used to stage weddings for long-legged Barbies. He arrived with his laptop presentation strapped to a box on a dolly, and he wheeled the arrangement into Simon’s little conference room.
Even though it seemed a risky proposal, Simon had suggested to Julie that she attend the meeting. “Want to know what I think? They might be testing this stuff for sexual whatnot, but I saw something in Florida that blew my mind. Here’s my father in bed, banged up and acting like—like nothing happened. And there’s no explanation for any of it, but then there’s this drug that appears all of a sudden. There’s something to this stuff, if I can trust my gut. It’s got some other effect. So are you coming? You might even learn something new,” he said glibly. He didn’t specify, but he hoped she might learn a thing or two about him. That he was a man who cared, for instance. She sat in the conference room, picking at her nails below the table, which Simon noticed for the first time were ragged and gnawed. He had not been able to fire her. He wanted to, but he was trapped, which was both frustrating and inconceivable. His staff liked him. His patients adored him. Even Gabi, who seemed to like no one and who despised everything American, appreciated him. But Julie seemed disenchanted with him and his practice. She appeared daily and she performed her chores, but she scowled under the surface. And yet, he couldn’t fire her because he’d made a mistake that looked like sexual harassment but was nothing like sexual harassment. When he thought about that moment in the basement, his stomach clenched. He couldn’t even explain to himself what had happened. All he could do, he realized, was include her in his plans and hope to win her over. Otherwise, he’d just have to pray she’d decide to quit.
Greg unhooked the bungee cords that strapped the laptop to the box. “This your residence, too?” he asked as he began to set up the computer.
“Office on one side. Home on the other.” Simon, intent not to reveal his nervousness, spoke too loudly for the small room. Julie refused to look at him, plucking at her cuticles.
“Gorgeous house,” Greg said, managing to compliment in a way that sounded greedy.
“We like it,” Simon said lightly. He had one eye on Julie, and he didn’t want to say too much. She oozed disgust for him, and it startled him. But he was eager for this meeting, and he had a feeling—that trembling in the gut again—that something important was about to happen.
“No worry about the commute to work,” Greg quipped.
“No, never.” Simon coughed into his hand.
“Okay. So.” Greg began his carefully rehearsed PowerPoint presentation with a computer-generated molecule, balls and ribbons in a three-dimensional structure like a Tinkertoy. “Sulmenamine’s not a new drug. It was originally derived from pine bark and was used at the end of the nineteenth century, principally for fainting spells or to restore calm. As you might imagine, they prescribed it most often for the ladies.” Simon noticed Julie staring back at Greg without changing her expression, but he could tell from her neck what she thought of the entire presentation.
As Greg revealed the next image, a sketch of the pine tree, Julie didn’t even look at the computer.
“It wasn’t in widespread use,” Greg went on with enthusiasm, “but there are accounts of doctors offering it in the South in small geographic pockets. Later, it was abandoned. We know the drug has no serious adverse effects and that it’s nonaddictive. We know it stays in the system for a long time.”
As Greg recounted the story, the Boeker research team had only just begun to explore the long-abandoned compound when they realized its structure resembled certain molecules in the brain. Simon glanced at Julie, who had folded her hands before her on the table and was sitting with impossibly straight posture. Her expression looked like someone waiting for a bus. Greg shifted to the next image, which revealed how the drug appeared to increase activity in certain areas of the brain. “This”—he pointed—“is where it’s happening. We believe the drug targets the prefrontal cortex, though there are perhaps other areas within the limbic system where it’s active.”
“Prefrontal cortex, you said?” Simon interjected suddenly and with volume, as if he could make Julie agree that the region mattered.
Greg moved around the side of the table alongside the laptop. “The evidence of biochemical activity there makes sense, being a pleasure center and all. It’s the brain’s reward system. Reward and motivation. There’s reason to presume the drug acts on neurotransmitters involved in sexual arousal, or at least provides the means to sustain feelings of pleasure.”
“So,” Simon began slyly, shifting sideways in his seat, “it’s just being tested for sexual dysfunction?”
Greg nodded. “Because it’s an old drug, it’s on the books, we were able to skip ahead quickly to efficacy trials.”
“But do you know exactly what’s happening there?”
“Hasn’t been determined yet,” Greg acknowledged. “But actually we suspect the process is fairly simple. You know all about endorphins, right?” Without waiting for an answer, he continued as if he were giving a freshman lecture. “Small segments of protein molecules that give a person a sense of well-being. The brain makes them and then breaks them down. All happens naturally.”
