by Harry Stein
PRAISE FOR
HARRY STEIN
AND
THE MAGIC BULLET
“A THOROUGHLY ORIGINAL THRILLER with great characters and a unique plot.… If you are tired of reading the same predictable plots over and over, try The Magic Bullet!”
—Phillip Margolin, author of Gone, But Not Forgotten
“[A] TENSE, DETAILED MEDICAL THRILLER … solidly crafted and engrossing narrative. Stein adroitly uses his characters’ flaws and desires to propel his intelligent story while raising provocative moral questions.”
—Publishers Weekly
“AN UNDENIABLE PAGE-TURNER, full of medical crises, attractive hospital personnel, juicy politics, and slam-bang suspense.”
—Booklist
“A rare and revealing insight into a world that few of us understand, but has life and death consequences for us all.”
—Nelson DeMille, author of Spencerville
“[The Magic Bullet] shows a novelist of great creative power.”
—Baton Rouge Advocate (La.)
“A REAL PAGE-TURNER. Harry Stein does to the medical profession what John Grisham has done to the legal profession.”
—Neal Gabler, author of Winchell: Gossip, Power and the Culture of Celebrity
ISLAND BOOKS
Published by
Dell Publishing
a division of
Bantam Doubleday Dell Publishing Group, Inc.
1540 Broadway
New York, New York 10036
All of the characters and companies in this book are fictitious, and any resemblance to actual persons, living or dead, or companies is purely coincidental.
Copyright © 1995 by Harry Stein
All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without the written permission of the Publisher, except where permitted by law. For information address: Delacorte Press, New York, New York.
The trademark Dell® is registered in the U.S. Patent and Trademark Office.
eISBN: 978-0-307-81530-9
v3.1
Contents
Cover
Title Page
Copyright
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11
Chapter 12
Chapter 13
Chapter 14
Chapter 15
Chapter 16
Chapter 17
Chapter 18
Chapter 19
Chapter 20
Chapter 21
Chapter 22
Chapter 23
Chapter 24
Chapter 25
Chapter 26
Chapter 27
Chapter 28
Chapter 29
Chapter 30
Chapter 31
Chapter 32
Chapter 33
Chapter 34
Chapter 35
Chapter 36
Chapter 37
Chapter 38
Chapter 39
Chapter 40
Chapter 41
Chapter 42
Chapter 43
Chapter 44
Chapter 45
Chapter 46
Chapter 47
Chapter 48
Chapter 49
Chapter 50
Chapter 51
Chapter 52
Chapter 53
Chapter 54
Chapter 55
Chapter 56
Chapter 57
Chapter 58
Chapter 59
Chapter 60
Chapter 61
Chapter 62
Chapter 63
Chapter 64
Dedication
Other Books by This Author
About the Author
It’s hard to imagine any author having a better experience writing a book than I had with this one. Leslie Schnur is a wondrous editor: smart, generous, and resourceful. Her colleagues at Delacorte—far too numerous to name—are likewise as good as they come. Joy Harris, my agent, was there throughout, ever wise and caring.
Particular thanks is owed to the respected oncologist who gave so unsparingly of both time and experience, thereby providing vast insight into the labyrinthian universe of high-stakes cancer research. Without this person, who chooses to remain anonymous, this book would not be remotely what it is.
The first change was infinitesimal—a mutation in a single nucleotide of a single cell, deep within her right breast. It is impossible to say what caused it, or even if it was necessarily destined to have any impact. Still, from that moment on, that cell was unique among the several trillion in her body. She was seventeen years old.
Over the next decade, the cell mutated several times. It began to behave autonomously, independent of the controls governing its neighbors. Its shape became slightly irregular. The structure of its nucleus changed. Its metabolism increased.
Her career was going exceedingly well.
Eight years later, the cell undergoes a sudden, dramatic change. The DNA within its unstable nucleus begins mutating hourly. All the cell’s energy is channeled into growth and reproduction. Normal signals directing it to stop are ignored. Immunological surveillance breaks down. Within a month, it has spawned close to a hundred daughter cells.
Sometimes she thinks she is living a fantasy. Between her two young children, her work, and her husband, she jokes that she doesn’t have time for problems.
It takes four years for the next great mutation. The malignant cells now number in the hundreds of thousands; but even if taken all together, are no larger than the head of a pin. Some, however, have already learned how to live outside the breast.
One afternoon, doing laps in the White House pool, she feels a dull pain in her lower back. She ignores it; seemingly just a minor muscle spasm. The backache lasts twenty-four hours and disappears as suddenly as it arrived.
Daniel Logan lay, motionless, on a gurney in a dim cubicle off the emergency room in New York’s Claremont Hospital. He’d been this way for an hour—alone in the dark, seemingly forgotten by the nurses moving in the corridor just a few feet away. Occasionally, in his semiconsciousness, he could hear a faint rumble of thunder; evidence that the storm battering the city this Sunday evening had not abated. As far as the emergency room personnel were concerned, he might as well not even exist.
Dr. Logan smiled. Good, this is just what he’d hoped for when he heard the forecast en route to the hospital, that business would be slow. God knows he needed the rest! He hadn’t made it home from that damn party the night before until nearly dawn, and he’d had to report to the ER at noon; the senior resident in charge of a skeleton crew of one intern, a handful of nurses, and a half dozen support staff. More than ever, he appreciated the sweet truth behind that most cynical of medical maxims: Sickness takes a vacation during lousy weather.
But abruptly Logan sat up, roused by a commotion in the hallway. Swinging off the gurney to his feet, he poked his head into the corridor.
A pair of security men were restraining a large, unwieldy drunk.
“Hey, Doc,” called one of the security men, “want some action on this guy?”
“Gimme a sec.”
The Claremont emergency room was like many others in large city hospitals. Waiting patients could peer through a glass partition into the doctors’ station where, in turn, the doctors and nurses could survey newcomers and assess which cases required imm
ediate attention; meanwhile charting the heartbeats of those already under their care on a large EKG monitor suspended from the ceiling. Strolling over to the ER reception desk, Logan instinctively glanced up at the monitor. Nothing going on. Only one customer waited on the other side of the glass, a young Hispanic man staring blankly into the middle distance.
“What’s his problem?” Logan asked Nurse Clancy—known as Nurse Amazon, even to her face.
“The drip. Dr. Richman’s already taken a culture.”
“Good.”
She smirked. “Must be pretty bad to bring him out on a night like this.”
Trust me, thought Logan, heading back down the corridor, if you had green stuff coming out of your dick, you’d be in here too.
The drunk was now sprawled out on the bed in a cubicle, held in check by four point restraints, one on each limb. Since the cubicle was designed to accommodate two people, one horizontal, the other vertical, Logan joined the group in the corridor peering within as a nurse drew a blood sample.
“You in, Doc?” asked an attendant named Ruben Perez.
“Wouldn’t miss it.” Looking the patient over, Logan tossed a quarter into the emesis is basin that was serving as the bank; there were already half a dozen others inside.
Logan prided himself on his skill at “Guess the Alcohol Level.” One early morning just the week before, a young Chinese man had been brought in appearing more inebriated than anyone they’d seen in months. The bids ranged from 400 milligrams per deciliter to 800; certain people would be dead at 700. Logan’s colleagues laughed when he came in at 275—until the fellow registered 295 on the computer. Logan alone had taken note of the key fact: Orientals invariably have a very low tolerance for alcohol.
Now Logan turned to Janice Richman, the young intern on duty. Shy and unassuming though she was, Richman had crackerjack diagnostic skills; tonight he was liable to have some real competition. “Okay, Richman, you’re up.”
“Five twenty.”
Logan nodded. “Put me down for four thirty.”
Five minutes later, assorted medical personnel, more than half the staff on duty, crowded around the terminal as a nurse retrieved the winning number from the computer.
“Four thirty-five.”
“Dammit!” snapped Richman, to Logan’s amused surprise. She’d never before shown her competitive side.
“Logan,” exclaimed Ruben Perez, “you’re a medical animal!”
Logan laughed, pocketing the change. “Hey, everyone’s gotta have a specialty. I happen to be a drunkologist.”
He smiled at Richman. “Janice, will you keep an eye on things? I’m gonna grab a bite to eat.”
“Yeah, yeah,” she said, “go blow your winnings.”
“I’ll join you,” said Perez. “I had a break due two hours ago.”
“I’m starved,” noted Logan as they headed downward in the elevator. “I open the refrigerator this morning and all I find is some moldy cheese and a bottle of beer. I’m telling you, if my patients saw how I live, they wouldn’t let me near them.”
“I thought all you Yuppie doctors know how to cook.”
“Nah, that’s the new cliché—I’m the old one. But I’m not complaining. I get to live on Chinese takeout and Hydrox cookies.”
Only a corner of the cafeteria remained open, and the only food available at this hour was from vending machines. As Perez wolfed down a cup of something passing as chicken soup, Logan poked at a container of Jell-O cubes.
“What are you doing, man?” smiled Perez. “The idea is to eat it.”
“Look, I’m trying to resuscitate some very sick Jell-O here.”
“By the way,” said the orderly, “I meant to ask—how’s that old guy Friedman doing?”
“Which one is he?”
“Christ, you doctors.…” He shook his head. “Fever? Abdominal pain? Low hematocrit? I brought him in around three o’clock. He looked septic.”
It was not unusual for orderlies to take an interest in their charges, but the depth of Ruben’s concern was exceptional; as was his understanding of medicine. When things were hopping in the ER, Logan could always count on him to direct him to the patients most in need of care. Born in the Dominican Republic and raised in the South Bronx, Perez was only a few years older than Logan; and the young doctor knew—and knew that Perez did too—that if he’d had more than a high school education, he’d have made a hell of a doctor himself. Though they rarely saw one another outside the hospital, over the course of dozens of conversations like this one, their mutual regard had slowly blossomed into firm friendship. Around Perez, Logan could readily drop the casual world-weariness that, on hospital grounds, so many wore as protective coloring.
“I stabilized him in the ER,” Logan replied, “and sent him up to intensive care.”
“He’s a nice guy. Think he’ll make it?”
Logan hesitated, then shook his head. “No.” He paused. “You’re right, after a while you almost do stop thinking of them as people. He’s a nice guy, huh?”
Perez nodded. “He was in the first wave that landed on Normandy, can you believe that? Great stories to tell. You know what he tells me when I’m wheeling him in? ‘This is what I get for eighty-seven years of bad living.’ ”
Logan smiled. “I’ll look in on him before I go. Promise.”
Perez stirred his soup. “So … tell me about the party.”
“Not much to tell …”
“ ‘Not much to tell,’ ” echoed Perez sarcastically. “The man attends one of the social events of the season and makes me read about it in the Daily News.”
“Hey, for me it was work.” Logan smiled. “I just went as a courtesy.”
In fact, the event in question, celebrating the thirty-five years in practice of Dr. Sidney Karpe, one of medicine’s most celebrated names, had gone exceptionally well for Logan. Karpe was a one-man industry: he wrote books, provided medical commentary for network news shows, featured a roster of celebrity clients as long as that of William Morris. If, as it happened (and as Karpe’s colleagues knew from firsthand experience), he was a mediocre doctor, that hardly seemed to matter. For his greatest skill lay in choosing associates—“accessory brains,” his envious rivals called them—to handle the nuts and bolts.
Which is where Dan Logan came in. The most gifted young doctor emerging that year from the city’s top medical facility, ideally suited for Karpe’s operation by training, temperament, and range of experience, he’d been wooed by the great man for months now; offered, in addition to a starting salary of $170,000, the kind of perks designed to dazzle a middle-class kid from the Midwest, from weekend yacht parties to regular trips to London, Paris, and the Middle East. And last night had been the clincher. At Karpe’s elbow, he’d met movie stars, politicians, and financiers; he’d been introduced as a soon-to-be partner in the practice.
But there was no way Logan was about to report any of that—not to Perez, stuck here at Claremont with little hope of escape. The money was too good, the perks almost embarrassingly grand.
“Fine,” said Perez, “did you enjoy the work?”
Logan smiled. “Some of the women,” he conceded, “were quite attractive.”
“Now we’re getting somewhere.”
“But you know how shy I am.”
“Yeah, right.”
“Really. A place like this, the women are way out of my league. Unless one of them has a medical complaint, I don’t even know how to get started.”
“Logan, you’re the kind of guy the women’s magazines are always talking about.”
“ ‘How to Meet Terrific Eligible Bachelors’?”
Perez grinned, surprised his friend had strolled into so obvious a setup. “Guys Who’ll Never Commit.”
“Anyway,” said Logan, brushing this off, “I felt incredibly awkward in that tuxedo. That’s not me.”
“You go to that place I told you? Did it fit right?”
“Yeah, it fit right. I wasn’t about to l
ook like a total jerk.”
Indeed, Logan knew he’d seldom looked better. Still boyish at twenty-nine, he was aware that his loping gait, longish hair, and quick smile could lend him the air of a spirited undergraduate; charming, but as unserious professionally as he remained about his personal life. This was an impression he’d gone to great lengths to avoid. Last night, he knew, he’d looked like a comer.
“So did you commit to Karpe?”
“Not yet.”
“Why not?”
Why not? The truth was, Logan fervently wanted it several irreconcilable ways at once. Ambitious for conventional success and status, he also clung to a brand of idealism that, had he advertised it, most of his colleagues would surely take as naive. Delighted as he’d be to find himself an object of envy, he also ached for plausible reasons to respect himself.
Too—and this was probably as vital as the rest—there was the matter of … sport. For Logan medicine at its best involved the skill and gamesmanship of basketball or high-stakes poker. It was fun to correctly diagnose an unusual condition or devise a creative treatment for an intractable malady; it could be nothing short of thrilling when a mix of intuition and hard work cracked a case that baffled other doctors. During the grind of internship and residency at one of the nation’s most competitive and unforgiving hospitals, it was those occasions that had given him moments of professional satisfaction that approached pure joy.
Logan knew full well that within Karpe’s practice the cynicism would be even more acute—and the opportunities for creativity even rarer.
“I guess,” he began haltingly, answering his friend’s question, “that clinical work, at this point …” He shook his head. “I mean, we both know how it can beat you up emotionally. That old guy—what’s his name again?”
“Friedman?”
“You won’t believe this, but there was a time when I’d have gotten incredibly involved with a guy like that.” He smiled. “Back in college I used to cry all the time at movies.”
“Hey, no one blames you. Big criers don’t inspire a helluva lot of confidence in patients.”
“I mean, even the way we talk about death around here. Notice how no one ever dies in a hospital?”
