The Magic Bullet (2 page)

“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 look 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?”

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.

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.