The Magic Bullet

by Harry Stein

  Though he’d been careful not to name names, the implication could hardly have been any clearer. Immediately, the vein in the older man’s temple began to throb. “I should not have to remind you that you are not Dr. Stillman! Nor do you have the standing to speak in such a manner of Dr. Stillman’s work!”

  “I was just trying to—”

  “Dr. Stillman knows enough not to cavalierly place his patients in jeopardy. He has never once placed the reputation of this institution at risk! Which, young man, whether or not you are aware of it, is precisely what your conduct has done! Do you understand what I am telling you?”

  Logan started to respond, then stopped himself. It was no good. This guy didn’t even know how to pretend to be interested in a dialogue. “Yessir, Dr. Larsen,” he said. “I’m sorry. What would you suggest we do now?”

  “I don’t suggest anything. You will do the following. How many patients remain on this protocol?”

  “With Mrs. Byrne off—I assume she is off …?” When the other only continued to stare at him, he pressed on. “That leaves thirteen.”

  “And they are continuing to come here to be examined on a regular basis, are they?”

  “Yessir.”

  He leaned forward in his desk chair. “Dr. Logan, it is not within my authority to close down this protocol completely. But it is to take those steps necessary to safeguard the integrity of the Department of Medicine.” He paused. “I expect you to inform each of those patients, on her next visit to the ACF, of the extraordinary risks we now know to be associated with this compound. Each shall then be given the option of leaving the protocol.” He shook his head, as if in consternation. “And I wish I were in a position to offer each of them my personal apologies.”

  Logan stood there, dumbstruck. In effect, he was killing the program. Was this the way it was going to end? Without his even making a coherent argument on its behalf?

  But he also knew that words were not going to mean a thing. And none came.

  “That will be all, Logan,” said Larsen suddenly, a military commander dismissing a contemptible underling. “Some of us do have work to do around here, you know.”

  10 August 1936

  Frankfurt

  The heat unbearable these last days. Still, dare not leave the apartment. Much trouble in this part of city—beatings, broken shop windows, etc.

  Must concentrate on financial outlook. By new laws, Emma can give piano lessons only to other Jews. Her father fears he will lose store. Some friends trying to get out.

  Since reduced to two days a week by Herr Thomas, have set up alternate facility in basement. So work uninterrupted. Early tests on version #531 of compound, new synthetic modification, show excellent potential. But laboratory supplies getting harder to come by, like everything else.

  To date, Logan’s firsthand experience with Marjorie Rhome had been limited to a brief introductory meeting. Sabrina had conducted the woman’s initial interview and shepherded her onto the program; subsequently, as these things went, her exams at the Outpatient Clinic had been covered by either Sabrina or Reston.

  Both confirmed Logan’s own first impression: that this woman was genuinely nice. Courteous. Cooperative. Above all—for, as he’d learned the hard way, this was the quality often hardest to come by in such a situation—possessed of real balance.

  “Mrs. Rhome is not a whiner,” as Sabrina had described it. “She—what is the expression?—sees things from others’ shoes. She knows that when the news is bad, it doesn’t always mean it is somebody’s fault.”

  Logan recalled this by way of reassurance. For Marjorie Rhome, the other patient with a creatinine problem, was due in for her exam this very morning—and it was Logan’s luck that he was going to have to conduct it.

  Even before his conversation with Larsen, that prospect had loomed as gruesome; after all, there was every reason to suppose that her creatinine level, too, had edged beyond the acceptable range and she would be obliged to leave the program. But now, even the slim possibility that her level would be encouraging offered no hope. For here he was, under orders to trash his own program!

  More than an hour later, sitting on a bench in the quad, watching the passersby on this brilliant summer morning, Logan could still scarcely believe it. He found himself trying to figure out exactly what he felt. Could it really be … nothing! But, no, retreating into his intellect, he recognized the reaction after all: shock. This was interesting, a whole different level of self-protection. Perhaps, if he was lucky, he would never feel its full effect.

  Sabrina was different; that was why he would wait to call her. No need to hit her with it yet. That would be selfish, self-indulgent. She was stuck all morning in Shein’s lab. She would need time to absorb the calamitous news, and also space—sanctuary from the inquiring gazes of their fellow junior associates and, even more, from the bully himself. It wasn’t so much (as in his case) the blow to career prospects that Sabrina would take as devastating, or even the affront to her pride. It would be the magnitude of the offense to her powerful sense of justice.

  Logan glanced at his watch: nearly noon. Where had the time gone? Slowly, as if the burden had been transformed into something physical, he bestirred himself and began making his way toward the Outpatient Clinic.

  Marjorie Rhome was waiting for him in an examining room, ready in her hospital gown.

  “Sorry I’m late,” he said, extending his hand, offering his customary version of a reassuring smile.

  “No problem, Doctor, really.” A heavyset woman with a pleasantly round face and sharp blue eyes, she seemed just as concerned with reassuring him. “I think we just finished up here a little early.”

  In fact, she’d already been on campus for some time, having blood drawn and posing for her monthly X ray.

  “Well, I hope they haven’t made things too unpleasant for you.” He realized as he said it that the words were coming by rote. He was on automatic pilot.

  “Oh, no, everyone’s been very nice. As always.”

  “And you’ve been feeling all right? No new special aches or pains?”

  “No, actually I’ve been feeling pretty darn well.”

  “Good.”

  Even as he continued to grin his idiot grin, he knew that soon he’d have to begin working toward the subject at hand: her future with the protocol—and the near certainty that there would be none. But, no, the results of her blood work should be in anytime now. He’d wait for those.

  “So,” he said, “if you’ll just take a seat on the edge of the examining table, we’ll try and make this as short and sweet as possible.”

  “Okay.”

  Before he began, Logan picked up her chart and scanned it. Yes, he was reminded, of course: Mrs. Rhome’s problem was intraparenchymal lung nodules—a dozen or so BB-sized growths in each lung field. Her prognosis could hardly be worse.

  He flipped to the page on her personal history.

  “So,” he said, “how are your kids?”

  Her face lit up. “Oh, fine, thank you.” She laughed. “But keeping me busy. You know teens.”

  “Actually, only by reputation.”

  “Of course, you’re hardly older than that yourself.”

  He smiled; imagining, in fact, the incredible degree of will this woman must possess to maintain even a semblance of a normal daily life. “It’s a boy and a girl, isn’t it?”

  “You got it. Jen, my daughter, just found out she’ll be the captain of the high-school soccer team next season, isn’t that a kick?” She laughed. “That’s the big event at our house. I guess it doesn’t compare to what goes on around here.”

  “Yes, it does. It compares favorably.” He moved over beside her. “Now, I want you to relax. Breathe normally.”

  He placed his fingertips on either side of her neck and began working down, feeling for supraclavicular nodes.

  “That’s good,” he concluded. “Still clear.”

  “Can I talk now?”

  “I really
don’t think I could stop you.”

  “Well, I just wanted to put in a good word about my son also. He’s pretty sensitive, so I like to give him equal time, even when he’s not around to hear it.”

  Logan smiled. He’d been trying to think who this woman reminded him of, and suddenly it hit him: Jane Withers, the onetime child star who’d grown up to be TV’s Josephine the Plumber. The physical resemblance was only part of it; even more so, there was the same relentless awshucks brand of optimism. “Go ahead, I’d love to hear about your son.”

  “Well, his name’s Peter.…”

  “Uh-huh. Mrs. Rhome, would you mind getting to your feet now?”

  She slipped off the examining table. “He’s fourteen. And you’ll never guess what he announced the other day he wants to be.…”

  Logan knew the answer; he’d heard this one before. “I have no idea.”

  “A doctor! It’s ever since I’ve been coming here.”

  Oh, God, he thought, she’s going to make this even harder than it is already.

  “I don’t know whether to be flattered or send him a warning.”

  She laughed. “Oh, I don’t think even you’d be able to discourage him.”

  “Now hold still a moment. Breathe in.”

  Gently, he felt her abdomen for the liver edge. He couldn’t feel it. Also good—the organ wasn’t yet distended.

  He was interrupted by a knock on the door. “Doctor?”

  This is what he’d dreaded: a nurse bearing the results of Rhome’s tests. He opened the door and took them.

  “Excuse me, Mrs. Rhome, just a moment.”

  “Take your time, Doctor.” She resumed her perch on the examining table and, to his surprise, began humming.

  There were three pages, but his eye went right for the line that mattered. “Creatinine: 1.9.”

  He didn’t know whether to be pleased or despondent. On the one hand, she was still below the cutoff; technically, she could remain with the protocol. On the other hand, he’d just been robbed of his easy out. Now he would have to discuss the overall ineffectiveness—no, he’d have to be more forthcoming than that—the dangers of this trial.

  She stopped humming. “What’s the word, Doctor? Good news?”

  “Status quo.”

  “Well, where I come from, no news is good news.”

  Talk about a dream patient! If only they could manufacture them to these specifications!

  Distractedly, he laid aside the blood results and slid the X ray from its envelope. “Mrs. Rhome, there’s something I’ve got to discuss with you.…”

  “Shoot.” But he could detect a trace of concern through the breeziness.

  “Do you know what creatinine is? Has anyone explained that to you?”

  “Not exactly.”

  He stuck the X ray onto the view box and snapped on the light.

  “Well, it’s a measure of kidney function.” He turned and faced her. “It’s one of the things we’re able to track through the blood tests.”

  “Is there some problem with mine? Because, frankly, I feel great.”

  “Well, yes and no. I’m sorry to say that we’ve had to take one woman off the drug because her creatinine rose to dangerous levels. Yours is not quite that high yet.…”

  He paused. That was strange. He was staring at her chest X ray. The lungs appeared clean.

  “But you’re saying there’s a danger of that?”

  “It’s something we have to watch.…” His voice trailed off as he examined the film more closely. “Excuse me, Mrs. Rhome, you did have a chest X ray taken this morning, right?”

  “Of course. Just a little while ago.”

  “And how long ago was the last one taken?”

  She shrugged. “Oh, I don’t know, two or three weeks ago.”

  “Excuse me just a moment, will you?”

  Taking the X ray from the view box, he held it sideways and read the name: RHOME. Putting it back in place, he looked at it once again.

  No way, someone must’ve mislabeled this thing!

  “What is it, Doctor?,” she asked, with sudden trepidation. “Nothing too serious, I hope.”

  “No, no … I’m just looking at something. Nothing to worry about.”

  He stepped across the room and picked up her file. He located her previous X rays—four of them, in chronological order. Taking up the most recent one, he read the date—“You’re right, the last one was exactly two weeks ago today”—and stuck it on the screen, alongside the other.

  No question about it.

  The X rays were Rhome’s. Both lacked a breast shadow on the right side, where she’d had her mastectomy. But one showed nodules, clear as day. While on this new one …

  Only now was Logan aware of his heart beginning to pound.

  “Doctor, can you tell me what’s going on? I feel a little like I’m in the dark here.”

  He turned to her with shining eyes, trying desperately to maintain a professional bearing.

  “Mrs. Rhome, Marjorie, I think I’m seeing something interesting on your X rays. Potentially very interesting.”

  “Good news?” Despite himself, enthusiasm was coming through, and this was not a woman who had trouble catching it.

  “I think so. Maybe. What I would like to do, if it’s all right with you, is have another X ray taken, just to be on the safe side.”

  “All right.”

  “And also call in my colleague, Dr. Como.”

  “Oh, of course! I like her.”

  “Excuse me for just a moment, please.”

  He picked up the phone and dialed the nurses’ station. “This is Dr. Logan in Examining Room C,” he said evenly. “I’m going to need another chest X ray on Mrs. Rhome. If you could get someone in here, stat.…”

  Hanging up, he turned to the patient. “A nurse will be in here soon. If you’ll excuse me just a few minutes …”

  As soon as he was out of the room, Logan dashed down the corridor. He grabbed the in-house phone in the doctors’ lounge.

  “Logan?” asked Sabrina, concerned. “Why are you calling me here?” Before he had a chance to respond, she suggested an answer to her own question—the one she had been dreading all morning. “This is about your meeting with Larsen?”

  In fact, the session with the head of the Department of Medicine—which only minutes before had been the central fact of his world—now seemed completely beside the point. “No, no. I’m at the Outpatient Clinic, can you get right over here?”

  “What for?”

  “Please, Sabrina, tell them anything. Just get over here.”

  She was there in ten minutes. “What, Logan? What did Larsen say to you?”

  “Look at this.”

  He handed her the two X rays and watched as she held them up to the window. “These are of Mrs. Rhome.…”

  “Yes. And so …?”

  But now, as she looked from one to the other and back again, he saw her expression begin to change; her eyes suddenly alive as the significance of the evidence before her became clearer. “These are the correct X rays? You checked?”

  “Absolutely. No question.”

  “I must see them in a light box!”

  “You won’t see anything different.” He paused, then, softly: “I tell you, Sabrina, it’s a miracle.”

  She’d never have believed she would hear Dan Logan say such a thing; like herself, like all dedicated researchers everywhere, he’d always defined himself, above all, as a skeptic. There were no miracles in medicine. Everything had a plausible explanation.

  But now she only nodded in mute agreement.

  “The question is what to tell her. She’s still waiting in the examining room.”

  “She doesn’t know?”

  “I wanted to talk it over with you first.”

  She sat down on the window ledge and again held the latest X ray to the light. “I think we must take another picture, no? To be sure.”

  “I did already. Sabrina, this is the second X
ray.”

  She nodded soberly. “Still, we must not give false hope.”

  “No. Of course not.”

  Such conservatism came with the territory. The fact is drilled into those who fight cancer from day one: Perspective is everything. While the lows may be as low as they seem, the highs are never as high. For, in the final analysis, there are no definitive cures for cancer, just more or less effective ways of keeping the killer cells at bay for greater or lesser periods of time. Even if the story suggested by Marjorie Rhome’s X ray held up—indeed, if on further investigation ninety-nine and nine-tenths percent of her tumor mass had disappeared—that meant there still lurked within her millions of malignant cells; any one of which could set in motion the process that would lead to her death.

  Still, even as they conscientiously went for dispassion, neither could long deny what they were feeling. Complete and utter elation.

  “So,” pressed Sabrina, “what should we tell her?”

  Logan erupted in a smile. “That’s the problem, isn’t it? Words don’t do the job.”

  Ultimately, they elected to let the patient make the discovery for herself. When they returned to the room, Sabrina again put the X rays side by side on the light box.

  “Would you like to see what Dr. Logan was seeing?” she offered.

  Rhome shrugged and walked over. “I don’t think it’ll mean heads or tails to me.”

  But as Sabrina indicated the nodules in the first picture, then indicated the same area in the second, entirely clear of tumor, Rhome turned to her with a sense of wonder that was almost childlike. “Does that mean what I think it does?”

  “It’s a very hopeful sign,” agreed Logan. “Extremely hopeful.”

  “This drug? It’s … working?”

  Neither Logan or Sabrina had yet dared to say it aloud, but suddenly here it was. “We have real reason to be encouraged,” said Logan.

  All at once there were tears in Marjorie Rhome’s eyes. “Oh, God! Oh, dear God!” And opening her arms wide, she drew Sabrina into a long embrace.

  “Hey,” said Logan, laughing, “I had something to do with this too.”

  Wiping away the tears with the sleeve of her gown, Rhome pulled away long enough to invite him into their embrace.