The Magic Bullet Read online

  Perez smiled. “Right. They ‘box’ or ‘crump.’ ”

  “Or ‘tube,’ ” added Logan. “Or ‘have their subscription canceled.’ ” He paused meaningfully. “I’ve just been thinking about how nice it’d be to do something else.”

  “For instance?”

  “Pure research.”

  Perez looked at him in surprise. “Like hell. You’re going to Karpe’s money factory.”

  Logan picked at his Jell-O a long moment, then looked up. “I want to show you something.” He reached into the pocket of his white jacket and pulled out a crumpled envelope. “This was in my box this morning.” He handed it across the table.

  Perez withdrew the single page and put on his glasses to read. It turned out to be little more than a form letter, coolly impersonal, Logan’s name slotted into the right place by a computer that, an instant later, had churned out the same letter to someone else.

  Dear Dr. Logan:

  Thank you for your application to the American Cancer Foundation. As you know, we are currently in the process of developing the roster of incoming fellows.

  I am pleased to inform you that you are among those selected for final consideration. As such, you are invited to visit the ACF to be interviewed by members of our staff. Please contact Dr. Shein, the supervisor of the Fellowship Program, at the number listed below to arrange for a mutually convenient date.

  We look forward to seeing you shortly.

  The signature at the bottom belonged to Dr. Kenneth Markell, the director of the ACF, one of the world’s greatest names in cancer research.

  Perez let out a low whistle. “I’m impressed. Save that for your grandchildren.” He folded the letter and replaced it in the envelope.

  “That isn’t why I showed it to you.”

  “What, you want my advice? How the hell should I know what to tell you? Just that you should be flattered.”

  “Hey, it’s a form letter. They probably send out a couple of hundred of these.”

  Perez grinned. “You want sympathy? You’re right, they probably do.”

  Logan rose to his feet. “Aren’t we supposed to have some work to do around here?”

  Back in the ER things had started to pick up. Four patients waited to be seen, among them a chest pain and a chronic asthmatic.

  “Where’s Richman?” demanded Logan of Nurse Clancy behind the desk.

  She nodded toward the line of examining rooms. “With a dirtball”—hospitalese for malingerer.

  Logan peered beyond the cubicle curtain. Richman was examining a woman of perhaps thirty, blond and very attractive. “Excuse me, Dr. Richman …?”

  Richman excused herself and joined him in the hallway.

  “What’s the story?”

  “Why, you interested?” She smirked. “Divorcée, two kids, Park Avenue address. Probably has a lot of money.”

  Logan rolled his eyes. “I mean, what’s her problem?”

  “I don’t know. Cough and fever. But the vital signs are okay.”

  “Well, don’t take too long. They’re starting to stack up out there.”

  Logan had the chest pain and the asthmatic placed in examining rooms and instructed a nurse to run the standard tests. He turned his attention to Mrs. Zaretsky and her three days of non-stop diarrhea. But abruptly there came a sharp knock on the examining room door: it was Clancy from reception reporting a crisis.

  The patient had been brought in by ambulance. Forty-one years old and in apparent remission from Hodgkin’s disease, she’d awakened with sharp abdominal pains. Logan glanced at her chart, then bent over the stretcher. He noted she was yellow-gray and her breathing was shallow. In the previous hour and a quarter she’d grown progressively shorter of breath.

  Logan knew he had a very sick woman on his hands. Instinctively, he felt her condition had nothing to do with the cancer; it was atypical for the disease to present itself so acutely. All things considered—abdominal pains, circulatory collapse, the fact that she was on steroids—sepsis seemed the likeliest possibility.

  Her husband hovered nearby. “What’s wrong with her, Doctor?”

  Logan led him to a corner. “I’m not sure. I’m going to put her on antibiotics. All indications are that she’s septic.”

  “What does that mean?”

  “There’s an infection in the bloodstream. What we’ve got to do now is find its source. Until then, the drugs should hold the infection down.”

  The man went ashen. “Oh, God, I should have brought her in three days ago.”

  He was right—but the rule was to keep them, at the very least, from feeling guilty. “It probably wouldn’t have made any difference. This seems to have happened quite suddenly.”

  The patient herself was fully conscious and scared to death. Logan placed his hand in her palm. “Listen, Helen, you’re going to be okay. We’re going to help you.”

  “But I’m having such trouble breathing.”

  “I know that. We’re getting you some oxygen so you’ll feel better soon.”

  Patting the patient gently on the arm, Logan headed for the nurses’ station. He needed to know how much oxygen she had in her blood.

  The station was vacant. “Nurse Clancy!” he called in frustration. He waited a long moment. “Goddammit, Clancy!”

  “What is it, Dan?” said Ruben Perez. “I’ll handle it.”

  He nodded. “Get me a blood-gas kit, and let’s set up a hundred-percent oxygen mask.”

  Abruptly the night nurse appeared. “What is it?”

  Though he was steaming, this clearly wasn’t the time for a petty doctor-nurse squabble. “Just wheel the patient from the ER into a room, please.”

  She caught his tone anyway. “I was in the john, for Chrissakes.”

  “Ruben,” he said, turning away, “I’m gonna need a set of X rays. And keep an eye on her blood pressure.”

  Logan rushed from the room and collared St. Pierre, the second night nurse. “Call up to the second floor—this lady needs a surgeon in a hurry. Pour in the normal saline, cover her with triple antibiotics, and give her a gram of steroid.”

  Ten minutes later she was wheeled off into surgery. Logan had been on the nose: a perforated duodenal ulcer, leading to septicemia and shock. No sweat—but another hour without proper treatment and she wouldn’t have made it.

  There was no time to savor it. As he headed back to the ER to check up on his chest pain, he was met by Janice Richman.

  “Here you are. Could you have a look at this?” She couldn’t quite hide the panic.

  “What?”

  Richman was already hustling back down the hall, leading the way. “That woman. I left her alone for a few minutes and …” Reaching the door, she opened it. The woman he’d seen earlier was totally transformed. Wild-eyed, her blond hair damp with sweat, she was trying to climb over the raised railings of the bed. In her struggle, the blue hospital gown had come undone and was hitched up to her waist.

  “What’s her name?”

  “Betsy Morse.”

  Logan rushed over to the bed. “C’mon, Betsy, take it easy! Tell me what the problem is.”

  She looked at him with wild, unfocused eyes; then flung an arm toward his face.

  “Betsy, calm down. Stay in bed. We’re here to help you.”

  He grabbed her by the shoulders and tried to ease her down; her skin was burning.

  “Betsy, relax. Relax!”

  Richman stood in the doorway, watching, shaken.

  “Richman, I need your help, for Chrissakes!”

  But the harder they tried to hold her down, the harder she fought. She was thrashing now, wholly out of control. People in delirium, stripped of the rational, are often astonishingly strong. It was all they could do to keep her in bed.

  Now she began making noises, grunts, and unintelligible nonsense syllables. Her face contorted, she was kicking violently.

  “Clancy,” yelled Logan, “get in here!” This time the nurse appeared almost instantly. “Tie her
down. Four-point restraints. Get security to sit on her. Get a rectal temperature, she’s hot as a pistol. One milligram of Haldol IM stat!”

  The doctors extricated themselves as security took over. “Let’s get her someplace we can hook her up to the EKG.”

  It was what any good doctor most dreads: the utterly inexplicable. Benumbed, Logan retreated to the doctors’ station.

  The young woman’s EKG tracing had already appeared on the overhead monitor: sinus tachycardia at 150 beats per minute. An instant later, Clancy’s head appeared around the corner. “Forty-two degrees.”

  “Cool her down, use lukewarm water, not ice!” commanded Logan. “Six hundred fifty milligrams of acetaminophen per rectum!”

  Above him, the monitor showed ventricular tachycardia—the chaotic fluttering of a severely injured heart.

  He ran to her bed, joining Richman and two nurses. She was out cold. Logan punched at her chest. No blood pressure. No carotid pulse.

  “Get a blood pressure cuff on her! Put a board under her back!” Furiously, Logan began cardiopulmonary resuscitation.

  “Get everybody up here. Call a cardiac arrest and set up for a respirator!”

  Seconds later the message thundered over the loudspeakers: “Cardiac team, emergency room, cardiac team, emergency room.”

  At this hour, Logan knew, it would be ten minutes before anyone arrived. He ordered saline pads applied to her chest. “Run up the paddles to three hundred watt-seconds!”

  The energy of the shock literally raised her from the bed. There was a sudden odor of seared flesh.

  Logan looked at the monitor. Flat line.

  “Keep pumping!” he screamed. “Where the hell’s the goddamn respirator?”

  One by one, bleary-eyed, the cardiac team rushed in.

  Logan and Richman stepped aside. While continuing to work at the young woman’s chest, the cardiac team began administering drugs pell-mell, desperately trying to flog the last living heart cells into action. One by one they failed.

  “Well,” spoke up Logan, with pretend calm, “anyone have any other ideas?”

  Silence.

  Logan snapped off the EKG. “Thank you, everybody.”

  “Another one in a box,” said one of the cardiac guys softly, trying to maintain his sanity.

  Glancing across the room, Logan caught Ruben Perez’s eye. He reached into his pocket and felt the envelope.

  The moment he entered the grounds of the American Cancer Foundation, crossing a narrow bridge over a meandering brook and steering the rented Taurus onto a long sloping drive lined with spruce and maple, Dan Logan understood why this place was always referred to as a campus. The ACF campus. With its vast manicured lawns and elegant Federal-style buildings, it instantly conveyed as strong a sense of dignity and purpose as any ivy-covered institution of higher learning.

  Like everything else here, that was by design. The Federal style is meant to awe—and its power had long worked on visitors far more important than Dr. Daniel Logan. To the powerful politicians responsible for much of its funding, as well as to researchers the ACF hoped to lure away from other institutions, these looked like buildings where serious work was done, serious science.

  Quite simply, there was no research institute, not in the United States or anywhere else in the world, remotely like the American Cancer Foundation. Founded in 1946, born of the boundless can-doism of the immediate post-war, the ACF now comprised some fifteen individual buildings. Here a small army of Ph.D.s and M.D.s worked toward the single goal of curing cancer. The ACF also contained its own hospital, the Eisenhower Medical Center, staffed by some of the finest oncologists in the world.

  Driving past a series of smaller buildings that he supposed to be labs, making note of a pristine wood in the middle distance, Logan couldn’t help but begin to muse: If he became a part of this place, he could accomplish something.

  Not that he had any illusions. This was just a lark, a day trip to satisfy his own curiosity. If he made the two o’clock shuttle out of National, he’d be home before five; there’d still be time to take care of a few things at the hospital before dinner.

  Still … behind the windows, moving about inside the labs, he could see people little older than he was. What important, even critical, questions were they working on this very moment? How many times, growing up, had he heard a TV reporter soberly intone “Researchers at the American Cancer Foundation today announced …”?

  Now, as he drew closer to the imposing administration building where he was to be interviewed, the sense of déjà vu from his college days was even stronger. Dozens of people, a handful of the more than ten thousand technicians and secretaries, scientists and administrators, employed by the ACF, moved along the sidewalks and across the lawns this early March morning; some leisurely, others hurrying as if they were late for an important exam. Many carried leather satchels or notebooks; the vast majority were in their twenties or thirties.

  Parking the car in the lot outside the administration building, he made his first appointment with five minutes to spare. It was with Raymond Larsen, the chief of the Department of Medicine.

  He knew the name, of course. Dan had seen it often in the prestigious Annals of Internal Medicine. The journal came every month, its name embossed in authoritative black capital letters on a light green cover, its pages thick and glossy. At Claremont everyone with even a pretense to a serious career devoured every issue, not only for its instructive value but as a defensive weapon. When you quoted the Annals, you quoted Scripture.

  And Larsen was one of the writers of Scripture.

  In the outer office, Larsen’s secretary, a charmless older woman, took his name and told him to take a seat. Before he’d even done so, Larsen himself hurried into the room. Tall and ramrod straight, he bore a distinct resemblance to Lee Marvin. He stopped and cast the secretary a look.

  “He here to see me?”

  “Dr. Logan,” she replied evenly. “A candidate for the fellowship program.”

  Larsen gave him a quick once-over. There was no evidence he liked what he saw. Wordlessly, he reached toward the secretary for Dan’s file. “Follow me.”

  For all his awe, Logan didn’t much like what he saw either. Larsen looked and carried himself like nothing so much as a marine drill sergeant, all brusque impatience and snarly command. He even wore a brush crew cut straight out of a fifties movie. How, he wondered fleetingly, does this guy manage to deal with patients?

  In his office, Larsen seated himself behind his desk and motioned for the younger man to take the seat opposite. As he leafed through the file, Logan studied the room. The walls were bare except for diplomas from Princeton and Harvard. The broad mahogany desk bore only a telephone and a neat stack of papers. No knickknacks. No photos of loved ones—if there were loved ones.

  But there were books, shelf after shelf of books, on all aspects of cancer medicine. Logan recognized some of the titles; he had consulted more than a few. ACF Director Markell’s tome—all four editions—were there. Sauerhaft’s Gynecological Malignancies. Then there was a volume by Larsen himself, Gastrointestinal Malignancies, wedged between two others whose bindings, once clean and crisp, were fading and cracked. Museum pieces—Logan wondered why he’d even keep them around.

  “I see you have a recommendation from L. D. Greiner,” spoke up Larsen suddenly.

  “Yessir.” Logan had studied with the Nobel prize-winning chemist as a postdoc in molecular biology at Stanford, before he’d changed course and opted for medicine. The esteemed scientist had been exceptionally warm to him, almost paternal. Logan knew that Greiner’s glowing report was one of the things that made his resume leap out from the pack.

  And yet, he abruptly realized, Larsen was taking it as a liability. “May I ask why you opted out of molecular biology just six months after you got your doctorate? It doesn’t say much for your stick-to-itiveness.”

  It took Logan just a moment to recover his wits. “I loved the work,” he said. “Being
in the lab with Dr. Greiner was terrifically exciting intellectually. It’s just that there was a … coldness to it. A lack of connection between what I was doing and any practical application. Whereas with medical research—”

  “You get to help people,” Larsen finished the thought—and, with horror, Logan realized that he was mocking him.

  “Something like that,” he agreed.

  “You realize, of course, that we have many promising applicants. And only a few slots to fill.”

  “Yes, I do.”

  “Good. I don’t like people to have any illusions.” He slammed the file shut. “Anything I can tell you?”

  Actually, he’d had many questions. Beginning with precisely the sorts of research opportunities he might have as an incoming associate. But Larsen’s invitation had been merely pro forma: it seemed that actual questions would only annoy him further.

  “No, sir. I’ve already done a great deal of reading about the ACF.”

  “Tell me, Dr. Logan, are you married?”

  The question caught Logan totally by surprise. What possible bearing could that have on anything? “No, sir, I’m not.”

  “I see.” Larsen rose to his feet and extended his hand. “Well, thank you for coming by. You’ll be hearing from us.”

  The interview, scheduled for half an hour, had taken less than ten minutes. It was forty minutes until the start of the next one. Shell-shocked, Logan was not even sure he wanted to bother going through with it. Over the course of his young career, he had been exposed to his share of unpleasantness: envy, duplicity, mean-spiritedness. He had come to understand that, by its very nature, big-time medicine tends to attract difficult personalities. But never before had he been the object of what he took to be outright contempt.

  How could a man with Larsen’s reputation as a physician and educator behave in such a way?

  Taking a seat on a bench outside the administration building, he withdrew from his coat pocket the folded copy of The Washington Post he’d bought at the airport. But, though he stared at the page, his mind wouldn’t fix on the words. He felt a dull pain behind the eyes, the beginning of a headache. Fleetingly—without even noting the irony—he wondered where he could get an aspirin in this place.