As the Compound J team waited outside the Administration Building’s third-floor conference room, Logan’s confidence soared. Exchanging greetings as the Board members filed in, the junior associates felt themselves to be among peers.

He was aware he even looked good. At Sabrina’s direction, both he and Reston had bought new suits for the occasion, conservative and far from the least expensive on the rack; almost as classy as the charcoal-gray Italian pinstripe suit she wore.

Logan, having been chosen to represent the team, had a twofold task: to summarize for the Board members the key points in the document they’d all already read, while conveying that they had what it took to see the project through.

Of the seven, Logan was already on a first-name basis with four: Dr. Lauren Rostoker, representing Surgical Oncology; Dr. Brendan Herlihy of the Department of Medicine; Dr. Myra Manello of Radiation Oncology; and, of all people, on behalf of Nursing Services, Marilyn Lennox. The remaining three had backgrounds not in traditional medicine, but in realms with which modern institutions must nonetheless concern themselves. They included a bioethicist based at Georgetown University; an Episcopal minister from nearby Annandale, Virginia; and someone from Patient Services named Marion Winston, a sort of ombudsperson for those receiving treatment at the ACF. But—yet another good omen—this last, a pleasant-looking, heavyset woman, took the time to introduce herself, shaking hands with each of them and wishing them luck.

The Board stayed behind closed doors for no more than fifteen minutes, presumably discussing the protocol in very general terms. Then the three junior associates were invited to join them.

“Well,” began the Department of Medicine’s Herlihy, chairing the meeting from the head of the conference table, “right off the bat, I must say a lot of solid thinking went into this idea.” He paused, waiting for those pleasant words to register. “However, as you know, we are able to approve only a very small number of protocol plans. Only those that meet the strictest criteria, not just for scientific merit but ethical accountability.” He nodded their way. “Now, I gather you, Dr. Logan, are speaking on behalf of the team?”

“Yessir.”

Logan rose and took a seat in the empty chair at the opposite end of the table. He smiled. “Ladies and gentlemen, on behalf of my colleagues and myself, I want to thank you for your time and consideration. I’m sure I have little to tell you today that you don’t already know. We are proposing a Phase Two pilot trial of the compound known as Compound J for metastatic breast cancer. In order for the trial to have appropriate statistical power, we feel we need to accrue forty patients over the next twelve months.…”

And he began to lead them through the case for Compound J; emphasizing, particularly to the lay people on the Board, the significance of the various reports of the drug’s activity spanning decades and great distances. “I will not pretend to you that we know more about this drug than we do,” he wound up, with what he hoped was just the right note of deference and candor. “But what we have already observed is compelling: clear evidence that this drug is capable of binding growth factors to their cell-surface receptors. The truly astonishing thing is that, as long as this drug has been around, it has never undergone a rigorous and closely monitored clinical trial for activity against this disease. That is a situation that, with your help, we now hope to rectify. Thank you.”

And nodding once again to the board members, he sat down.

“What about your Informed Consent Document?”

It was Winston, the patient care rep.

“Pardon?”

“Is it your position that this document displays sensitivity to the needs of the women you would enlist for such a trial? That it serves them well?”

Logan hesitated. What could she be getting at? “We think the Informed Consent Document does what it is supposed to do,” he offered finally. “Which is present all the most likely problematic scenarios.”

“Oh, does it? Dr. Logan. As you’ve acknowledged yourself, this is a very toxic drug. I am not a physician, but I have it on the very best authority that you do not come close to covering all likely eventualities. For example, you never even address the possibility of cerebral hemorrhage. Or heart attack.”

In fact, the woman was only confirming her ignorance—of all the possible calamitous effects of Compound J, the chances these were among them were infinitesimal. Still, Logan worried she might be scoring points with the others; following Shein’s instructions to the letter, in the final draft of the proposal, they had passed lightly over the unsettling matter of side effects. He was suddenly aware that the room seemed to be overheated.

“Ms. Winston, I really don’t think the possibilities you raise merit serious consideration.”

“The point, Doctor,” spoke up the bioethicist, “is that some of us feel that a less than thorough investigation has been made as to the downside of this drug. Some of us feel that rather strongly.”

There was a superior note to the guy’s tone that drove Logan crazy. What the hell did he, who’d never in his life so much as touched a patient, know about the thoroughness of their investigation? He felt like diving across the table and taking him by the throat.

“Well,” he said evenly, “all I can tell you is that we’ve spent a great deal of time on this. Certainly, if we’d been completely exhaustive, other possible eventualities might have been listed. I acknowledge that. But it would have been pure speculation. That’s the point: we need to know more about this drug.”

“I see”—Winston again—“and you’re planning to use these patients as human guinea pigs.”

“I didn’t say that. That’s not fair.” He stopped, collected himself. “Isn’t it fair to say there’s a certain degree of uncertainty in a test of any new compound?”

He looked hopefully at the medical personnel around the table: the surgeon, the radiologist, the nurse. Surely, they were with him on this.

But no one gave a word of support.

“Dr. Logan,” said Winston, her voice taking on a dangerously hard edge, “we are not raising these questions in a vacuum. We must all be aware of the fact that the public’s confidence in breast cancer trials has been badly shaken in recent years by doctors more concerned with their own reputations than with the well-being of patients. Frankly, in your case, we would find such questions less troubling if certain other aspects of your history had not been brought to our attention.”

He tried to smile. “Ms. Winston, I really have no idea what you mean.”

“Are you aware of a patient at the ACF named Rochelle Boudin?”

Logan felt his stomach rising, the beginnings of nausea. He stole a glance at Lennox, but she was looking down, making notes on a legal pad. “Yes, I’ve been one of the doctors who’s helped care for Rochelle Boudin.”

“I gather from that response that you feel your care has been adequate.”

“Yes. I would say very much so. She appears to be in complete remission from her disease.”

“It is fair to say that the patient does not share that assessment. I have interviewed Ms. Boudin personally.” She held aloft a notebook in grim triumph. “Perhaps you’d be interested in some of what she has to say.” She opened the book. “She describes you as—this is a quote—’ the most insensitive doctor I’ve been exposed to at the ACF.’ She says you are chronically indifferent to her needs. She says—again I quote—she feels ‘you look for ways to take advantage’ of her, and she feels you rarely if ever tell her the full truth.” She closed the notebook. “I could go on.”

Never in his life had Logan been faced with such a thing. By temperament, he simply was not equipped to deal with it. “I could probably say a few things about Rochelle Boudin too,” he offered lamely.

“She is not the one asking for authority to conduct a protocol.”

“So,” he added, “could almost everyone at this place who’s had to deal with her.” He looked toward Lennox. “I think Nurse Lennox might confirm that.”

Lennox looked up from her pad, her face going red. “Sometimes she can be difficult.”

“You are aware that Ms. Boudin is a patient on one of Dr. Larsen’s protocols?”

“I am aware of that, yes.”

“Well, I must tell you that Dr. Larsen fully shares her view of the situation. Are you now going to tell us that Dr. Larsen is incompetent to make such a judgment?”

So that was it? Larsen! Abruptly, Logan was overwhelmed by a sense of helplessness. It was over. There was no way to fight this.

“Ms. Winston, I don’t know what you expect me to say. I’ve done my very best with Rochelle Boudin, as I have with all my patients. I—”

“Look,” he was interrupted, “this is absurd. We’re talking about the wrong things here.”

The voice was unmistakable, but Logan jerked around to see for himself. Shein was standing just inside the door. There was no way to know how long he’d been in the room.

“You want to talk about the Informed Consent Document?” he picked up. “Fine, blame me. I’m the one who told ’em to make it short and sweet. But, Christ, you don’t throw out the goddamn baby with the bathwater!”

Shein’s intrusion, as everyone in the room knew, was highly unorthodox. But they also knew—and Shein better than anyone else—that no one was about to stop him. Now he moved to the table and stood beside Logan.

“What the hell are we really here for?” he picked up. “I don’t mean just in this room but at this institution. We have a major problem in this country with cancer, and an especially major one with breast cancer, okay? And don’t think we’re making such strides against this disease. The mortality rate is the same as it was twenty years ago. Nobody wants it that way. But the bottom line is, we still don’t know what the hell is going on.

“Now, our friends here have come up with an idea that seems—that may—attack this thing at its roots. In my considered view, based on twenty years in the business, this is a novel and rational idea that has been thought through very carefully. And as such it represents a not irrational hope for women who otherwise have no hope.”

Pausing to look around the table, he drove the point home. “So I’m asking you now to put aside the politics. Put aside the bullshit and the arguments about things that don’t matter. Because we all know that no one who’s terminally ill gives a damn about anything but trying to get well. Those people have only one question. They look their doctor in the eye and say, ‘Should I go on this protocol?’ And if the doctor believes in his or her heart it’s the right thing, then that patient will go on that protocol. That’s reality. It may not fit the textbook theories, but that’s the way it is.”

He paused. “And I’ll tell you one other thing. If, God forbid, it were my wife, I’d sure as hell want her on this protocol—even if I don’t know every one of the goddamned toxicities.”

It took the Review Board, meeting in private, little more than a half hour to reach its decision. The Compound J team was granted a modified protocol—a smaller and more closely monitored version of the one they’d proposed.

The note on the bottle of champagne that arrived at Seth Shein’s door that evening didn’t even try to be clever. The words, in Logan’s hand, appeared above the three signatures: All the gratitude we can ever express will never be enough.