Authors: Harry Stein
“Coopersmith?” asked Reston. “What kind of protocol?”
“What difference does it make? What matters is he made it happen.”
“In other words, it was a bust.”
“Actually, I don’t know. I found the record of the proposal but not the results.” As they both knew, this was not unusual; protocol data could run hundreds of pages and were generally filed away on computer discs. “Anyway, it was something about shooting radio-labeled antibodies directly into the bloodstream to go after prostate tumors directly instead of relying on standard chemo. Interesting idea.”
“Prostate? Who’d he get to sponsor this, Larsen?” The very idea was almost beyond imagination.
Logan shook his head. “A genitourinary guy, someone named Locke. I think he’s now in private practice.”
“So—what are you saying?—now you want to go off and do something on your own? You?”
“
Us
. Maybe. Why not?”
“Why not? Because, frankly, I don’t even register on their radar around here. And—don’t take this the wrong way, Danny boy—but you’re not exactly known for your guts.” Reston stopped, drawing it out; on some level he was enjoying this. “So just don’t pull my chain, all right?”
Stunned, Logan was momentarily silent, then came back with surprising heat. “I’m just trying to … What the hell do you think gives you the right to—”
“Look,” Reston cut him off. “I’m just saying I don’t need your pipe dreams right now. I’ve got my own problems.”
“Fine,” snapped Logan, his face flushed. “Forget it.”
Reston smiled. “Hey, don’t go away mad. I’m perfectly willing to talk—as soon as you’ve got something serious on the drawing board.”
I
n fact, Logan had been toying with the beginnings of an idea for weeks—ever since the morning Larry Tilley had stepped into his examining room.
For Tilley was potentially one of Gregory Stillman’s famous secret-bearers: a patient in whom disease so defies expected patterns that his case forces a competent researcher to rethink old assumptions.
A Kansas City lawyer, thirty-four and gay, Tilley was on a Phase Two AIDS protocol for a drug called Compound J designed to interfere with viral reproduction—a protocol that seemed to be going nowhere. To date, Compound J appeared to be totally inactive.
No real news there. The AIDS virus had long been a particular source of frustration to ACF researchers, on a par with the most baffling cancers in its sinister complexity. AIDS protocols were notoriously ineffective in yielding practical results, and as Shein one day put it, with characteristic gallows humor, “when one of those mothers bites the dust, it takes a lot of people with it.”
As a protocol patient, Tilley was unaware of this, of course. He had come in from Kansas City for a series of tests. His numbers, like those of most on the protocol, were not good.
But within minutes of the start of the examination, he casually mentioned something that got Logan’s full attention: Though he’d been feeling dizzy and weak a lot lately, it had nothing to do with overactivity. “In fact, it usually happens when I’ve been resting. I get up from a chair and I feel like I’m going to faint.”
Logan, who’d been checking his lymph nodes, paused—what
could
that
be about?—and momentarily excused himself. In the adjoining room he looked more closely at the paperwork forwarded by Tilley’s local hospital.
Unable to pinpoint a cause for the unusual course of events, his private physician had first put forth a likely diagnosis of pancreatitis—a simple inflammation of the pancreas. After a couple of days in the hospital, feeling better, Tilley had been sent home. But, literally within hours, the problem was back.
Logan returned to the patient. “You seem to have stumped your doctors back there.”
Tilley smiled. “They kind of threw up their hands and said I should come here to let you guys figure it out.”
Logan liked Tilley immediately. No self-pity, lots of fight.
“All right, let’s figure it out. Why don’t we start with an easy one? How do you feel when you stand up?”
Sure enough, Logan noted that every time Tilley rose to his feet, his blood pressure dropped precipitously and his heart rate increased.
“Well, we’ve established that the problem isn’t your imagination.”
“Great. Even the boobs out in K.C. knew that.”
Logan laughed. “Did the boobs ask if you’ve been thirsty a lot lately?”—worth asking, but just barely. From his days at Claremont, Logan recalled that such simultaneous changes in blood pressure and heart rate can be symptomatic of extreme dehydration; though on this cool fall day, it seemed almost impossible that a man not engaged in vigorous physical activity could become so seriously dehydrated.
To his surprise, Tilley nodded. “But that’s just something that comes from taking the drug, isn’t it?”
“Well, let’s see if this boob can clarify that a bit further. I’m going to want to run some tests.”
“Does that mean I have to go back in the hospital?”
“I don’t think that’s necessary. We have contracts with
a number of hotels in the D.C. area. Why don’t we just have the ACF give you a free vacation?”
Tilley smiled. “Thanks, Doctor.”
“I’ll have someone make a reservation for you at the Madison Arms. Be here tomorrow at eight-thirty and we’ll get started.”
“How long am I gonna have to stay?”
It was part of Logan’s job to allay apprehension, but he would never intentionally mislead a patient. “I really can’t tell you, Larry. Probably no more than a few days. In the meantime, I’m going to give you a couple of liters of intravenous fluids and see if that helps.”
Briefly, it looked like a miracle cure. By the following day, Tilley reported he was feeling better than he had in months.
But the day after that, the dizziness was as bad as ever.
As test after test came up dry, the patient’s few days in Washington became almost two weeks. Disappointed as he was on Tilley’s behalf, Logan’s curiosity continued to mount. Every second day Tilley arrived at the ACF clinic to be examined and pumped full of salt water. Sure enough, he would feel better; yet, just as surely, within two days he was dizzy again, his blood pressure dropping sharply.
Finally, at long last, the tests yielded up the reason for Tilley’s persistent dehydration. His adrenal cortex had ceased to produce the hormones that enable the kidneys to retain salt and water. To Logan, the reason seemed apparent: the protocol drug was somehow blocking the normal function of the organ.
And yet, going over the lengthy proposal that had led to the Compound J test, he found nothing to indicate that the drug might have so alarming a side effect. Nor, as far as he knew, had it so affected even one other patient on the protocol.
The afternoon the test data came in, Logan could focus on nothing else. It simply didn’t make any sense: what was it in the makeup of this patient—or in the specifics of his
condition, or in some heretofore unrecognized aspect of the drug itself—that could have produced such a result?
Yet already he had begun to formulate an even more pertinent question: Could such a discovery have some meaningful practical application?
The day’s events crystallized in Logan’s mind an intention that had earlier been only a vague thought: he saw Shein’s secretary and picked up a ticket in the ACF box for that evening’s ball game. His favorite team, the California Angels, was in town, and since boyhood he had done some of his best thinking at the ballpark.
Arriving at Baltimore’s Camden Yards early for batting practice, he was not surprised to find himself alone in the box—he’d heard it was seldom used.
The box was on the mezzanine level, slightly to the first-base side of home plate, and Logan had a commanding view of the stunning new stadium. He bought himself a hot dog and beer and settled in, reveling in the feel of the place.
It wasn’t until the fourth inning, with the Angels already enjoying a three-run lead, that he reached into his briefcase and withdrew Larry Tilley’s case history. His plan was to review it from the beginning, prior even to the diagnosis of the disease; looking for some clue in Tilley’s past, anything that might—
“Dan?”
He looked up and there, to his astonishment, a cardboard food tray in her hands, stood Sabrina Como.
She smiled uncertainly. “I hope you do not mind to be bothered.”
Hurriedly, he replaced the papers in his briefcase. “No, of course not. I’m just … surprised.”
“Most times no one else is here.” She took a seat beside him.
“Aha …” He stared at her wonderingly. “You like baseball?”
She nodded. “It is a game of numbers. I like numbers,
my mother teaches statistics.” She pointed at the scoreboard in right field. “The Orioles, they are not doing so very well. Only three hits and two errors already.”
He nodded. “Tim Salmon hit a home run for the Angels.” This was
crazy;
no way she could know who Tim Salmon was.
“And Bo Jackson? That is a big reason I came—to see a man with a hip replacement run around on the bases.” She smiled. “That is a
real
medical miracle, no? Better than our little tricks.”
He smiled uncertainly. “I know. Unfortunately, he’s not playing.”
“No … I know he is hitting only .233, not so high.” She was staring down at her scorecard, matching the numbers listed on the board in centerfield with those in print. “Tonight instead they use this other man, Davis.”
Logan was overwhelmed. He couldn’t have dreamt up such a woman. He strained to think of something to say. “So … what are you eating?”—then instantly berated himself.
Why was it that every time this woman spoke to him forty points seemed to drop from his IQ?
She picked up the hamburger from her tray. “Not the best.”
“Well, at least it beats the food at the ACF.” He hesitated. “Is hospital food any better in Italy?”
“No, maybe even not so good. What could be worse than days-old pasta? But there the doctors may bring their own food to eat. Sometimes I do the same here—Italian pastries and chocolates.”
Reaching into her pocket, she withdrew a piece of candy wrapped in gold foil. The label read
Maracini
. “Would you like?”
He unwrapped it and popped it in his mouth. “It’s delicious.”
“They are not to be eaten so fast, Logan,” she said, smiling. “They are not Hershey’s Kisses.”
“Oh. Sorry.”
“I give them sometimes to my patients in the hospital.”
“You do?” Fleetingly, Logan wondered if that might violate some regulation.
She shrugged. “I started this practice back home. In the hospital there we had many children.”
“A pediatric ward?”
She nodded. “But it is good with adults too. Such a small thing, but it helps create good relations with patients.”
“I find it pretty hard working with kids.”
“Pardon?” He’d said it so softly, she actually hadn’t heard.
“I don’t know, when I go into a children’s ward and see those little tables and chairs …” He hunched his shoulders slightly. “I have trouble even reading the literature about kids and cancer.”
Though her gaze didn’t waver, she studied Logan with new interest. “Well, you are very lucky then we do not treat children at the ACF.”
“No.” He hesitated, struck by the change in her manner. An explanation seemed in order, if not an apology. “I know it’s not very professional …”
She turned away to stare out at the field. “Ah, Mr. Ripken is coming to bat.”
He felt a rising sense of alarm. “So,” he picked up, “are you enjoying your work at the ACF?”
“Enjoying?” She turned back to him, seemingly baffled by the word. “It is like a medieval Italian city-state, I think. It makes me go back and read Machiavelli.”
Gratefully, Logan burst out laughing. “That’s true.”
“Some of the people there … just
horrible
!” She paused. “You are not friends with them, I hope.”
“No. It’s strictly professional.”
“Like this Larsen and Stillman. Among the greatest experts in ovarian cancer and breast cancer—no?—and they do not like women. Not at all. How could such a thing happen?”
On the field, the Orioles were rallying, and the crowd
let out a roar as a ball shot between a pair of infielders into left field. Logan shook his head. “I really don’t know.”
The crowd noise died down. “Even the work—it really is not so interesting as I expected.”
“I think a lot of us feel that way.”
“Back in Florence—this is where I did my training—I had a year of specialization in endocrinology. You see? But here”—she offered a helpless shrug to indicate the immensity of her frustration—“here what is the use of such a specialization?”
“I didn’t know you were an endocrinologist,”
“Yes, and very good too.” She laughed. “No good hiding it under a bush.”
Her laugh was a lovely sound. He leaned forward. “Listen, I’ve got something you might be interested in.…”
He withdrew the pages from his briefcase; then, in broad strokes, he outlined the Tilley case, stressing his continuing confusion over what appeared to be the patient’s bizarre reaction to the protocol drug.
Eyes fixed on the field, Sabrina listened intently. “You are sure in the protocol proposal there is nothing at all about such side effects?”
He shook his head. “Absolutely not. Who knows, maybe it has nothing to do with Compound J. Maybe it’s a result of the disease itself.”
“You know,” she said, “I have several patients also on the Compound J protocol. One of them, she has similar symptoms.”
“Weakness? Dizziness? Dramatic change of blood pressure?”
She nodded. “Only not so severe. Her doctor in New Jersey, he is handling it.” She paused. “You have been to the library at the Foundation? You have checked for information on Compound J?”
“I’ve just made a start.” In fact, the ACF archives had the vastest collection of data on cancer and related diseases anywhere in the world; and most of what it didn’t have was retrievable electronically. The only real limits on a dedicated
researcher were those he imposed on himself. “Unfortunately,” Logan confessed, “I’m not strong in languages. Only English and some German.”