Before the end of the summer Daniel Logan was entirely at home at the ACF. He found what was asked of him was no more than he’d always asked of himself: lots of hard work and the willingness to take on more. “This place,” as Seth Shein put it to him one afternoon, in one of their increasingly frequent chats, “is the last true meritocracy. Like God, the ACF helps those who help themselves.”
The routine into which he’d settled may have been the standard one for junior associates: three days a week working the hospital; the other two in the clinic, dealing with protocol patients on an outpatient basis; between the cracks evaluating new candidates for possible acceptance into ACF protocols in the Screening Clinic. Yet, almost alone among the junior associates, Logan’s work had never been singled out for criticism.
Quite simply, he took the protocols as a sacred trust—eliciting consistent cooperation from even the most difficult patients and making himself so familiar with his patients’ medical histories, so alert to subtle changes in their appearance or test results, that already he’d headed off several potential crises.
His superiors had been equally struck by his work in the Screening Clinic. For a protocol to yield the best possible results, every patient on it must perfectly match the profile established by its creator. Working with biopsy slides of promising candidates forwarded by their local pathologists, Logan actually came upon more than one misdiagnosis.
It was as if all his years of training—hell, his entire existence—had been preparation for his work here. A skeptic by temperament and experience, he never accepted the seemingly obvious at face value; questioning all assumptions, carefully scrutinizing even routine incoming data. Yet, unlike most of his contemporaries, he could also make the creative leaps so essential to problem solving.
Under the circumstances, he had little trouble understanding that some of his peers took his success personally; in their place, he might have felt the same way. At the ACF, more than at any other institution he’d known, another’s rising status could feel alarmingly like one’s own failure. So he tried to accept the inevitable sniping with relative good humor.
“Hey,” as Barbara Lukas nodded in greeting one early morning, “got your Chap Stick ready? We’re going on rounds with Larsen.”
“So?”
“So who knows how many asses you’re going to have to kiss?”
Smiling, Logan patted his breast pocket. “No problem, I always keep some handy.”
“What is it with you, Logan? Don’t you even have the self-respect to be insulted?”
“Not if that’s the best you can throw at me.”
For all the trouble she gave him, Logan liked Lukas. Insecure, easily provoked to anger, far too outspoken, she herself had proven completely inept at the gamesmanship that seemed so vital to success at the ACF. In fact, this tiny, combative Duke grad had already been pegged by their superiors as a headache likely to blossom into a migraine.
But Logan was perceptive enough to know it was the toughness that had gotten her here; and to recognize the vulnerability behind it.
Then too—and this always counted heavily with him—he was aware that she was a truly gifted doctor.
“Look,” he tweaked her now, “if you’re looking for personality guidance, just ask. For starters, Barbara, you gotta start smiling more.”
“Hey, and maybe you oughta consider wearing a real short skirt every once in a while. That’s guaranteed to win these guys over.”
“Not funny,” she said, suppressing a smile.
He shrugged. “Just trying to help.”
“Thanks,” she said, turning on her heel. “And you should start smiling a lot less.”
In brief, Logan was starting to feel he was one of the chosen. Lukas had it right: somehow, remarkably, thus far he had managed to remain on good terms with everyone who mattered. Either directly or by inference, half a dozen of the senior men had indicated that, when the time came, he would be welcome as a member of their team.
Indeed, he’d already begun viewing the day when he’d have to actually make such a choice with apprehension. The consequences—possibly on the entire course of his career—were incalculable: the implacable enemies it would create, the doors it would forever slam shut.
Just now, even Larsen seemed to be nurturing newfound regard for him. Logan figured this out the day Larsen unexpectedly took a seat beside him in the hospital cafeteria and began making his own tortured version of small talk.
“So,” began Larsen, “you come to us from Claremont Hospital.…”
Given that they’d been over this territory months before at his initial interview—and Larsen had been singularly disinterested in the fact then—Logan was at a loss. “Yessir, that’s true.…”
Larsen nodded. “Very good, very good.…”
“Thank you.” Logan bit into his burger, to keep his mouth occupied.
“I understand they have a lot of wealthy Arab patients up there.”
Logan nodded; in fact, at one time or another, the place had played host to half the Saudi royal family. “Yessir, that’s true.”
Astonishingly—for it was the first time the younger man had ever heard such a thing—Larsen laughed: a dry, reedy sound, more like the clearing of the throat than anything suggesting joy. “I guess they know the score. When the chips are down, they run right to those Jewish doctors.”
He laughed again and, rising to his feet, clapped a hand on Logan’s shoulder. “Keep up the good work, young man. Perhaps we’ll have a chance to work together more closely one of these days.”
“I’d like that, sir.”
Not that he trusted Larsen for a minute. He knew how quickly the volatile chief of the Department of Medicine was liable to turn on him; and how, once incurred, his displeasure seemed to grow ever more dangerous.
He was reminded of this the very morning of his exchange with Barbara Lukas. Less than an hour afterward he and Lukas were among the five first-year associates escorted by Larsen on their weekly teaching rounds. The group had visited four or five patients, Larsen holding forth after each visit in the corridor outside the patient’s room, when they entered the room of Congressman Al Marino.
Marino was in for colon cancer. A ranking member of the House Science and Technology Committee, he was one of the handful of patients on the premises who enjoyed nonprotocol status.
“Al, my friend, how are we doing today?” boomed Larsen, with a sudden ingratiating smile. The junior associates exchanged furtive looks; with every one of the patients they’d seen earlier, he’d been coolly impersonal to the point of rudeness.
The congressman, sitting up in bed before a pile of documents, bifocals perched on the end of a bulbous nose, hardly moved. “I’m doing shitty. How are you doing?”
Larsen moved over beside him. “I know that last course of chemo was a little rough. I’m sorry.”
“Yeah,” he said disinterestedly.
“Carol’s okay? I had a nice phone conversation with her a couple of days ago.”
His reserve of happy chat exhausted, the doctor pulled out his stethoscope and got to work. “You know the drill, Al,” he said, summoning up a last bit of good cheer, “—heart, lungs, and abdomen. Nothing to it.”
Running through the rote procedure in less than a minute, he called for the congressman’s progress chart. As he read it, his brow darkened. “Dr. Lukas,” he suddenly spoke up sharply, “are you responsible for this?”
She hesitated, a doe caught in headlights. “Yes, sir.” But, characteristically, she instantly drew herself up straight, determined not to appear intimidated.
“Would you mind telling me why these lab values are written in pencil?” The throbbing vein in his left temple was a familiar sign of building rage. “Were those lab values temporary? Was it your intention to go back and change them?”
“No, sir. It was my understanding that—”
“Excuse me, Doctor? WHAT was your understanding—that we encourage incompetence at this institution?”
“No, sir, if you’ll allow me to finish?”
“No! I will not allow you to waste Congressman Marino’s time or mine!”
Suddenly the chart was flying across the room in her direction. “This kind of sloppy work will NOT be tolerated, Dr. Lukas. I strongly suggest you learn proper procedure by studying one of Dr. Logan’s charts!”
He turned to the patient, who seemed disinterested in the whole thing. “I’m sorry, Congressman. I hope you won’t take it as the way things are done around here.”
“Forget it, she’s just a kid.” He gave a wave of his hand and added the words that this day would spare the young doctor further torment. “Why don’t you lay off? She’s kinda cute.”
Lukas stared straight ahead, unblinking, but Logan caught the stricken look in her eyes. He wanted to let her know how mortified he was to have been made part of her torment.
But too, at that moment, on some level, his thoughts were on his own future. Like it or not, Larsen was not a force to be slighted, let alone ignored. Shortly, in spite of everything, when faced with the decision of which of the top guys to go with, he would have to consider that fact very, very carefully.