The Breakthrough

“Did you hear about the big breakthrough on the news last night?” the patient said in an expectant voice, startling me as I edged past his bed on my morning rounds.

I knew the man as Roy Carver, but I had never spoken to him before. He was the roommate of one of my patients, but usually, when I was rounding, Carver would be concealed by a curtain drawn around his bed, either asleep, drugged, or reclusive.

I turned toward Carver, who was propped on pillows. He seemed ready to cross the boundary that separates sickness from terminal illness. I placed him in his 40s, but his body was shrunken. His skin looked stained and waxy. I knew, just by sight, that he had cancer consuming him.

“Tell me what you heard,” I said.

“Something big. Dan Rather said it was a cure for cancer and it was found right here at the medical center.” He paused to breathe. “I thought all the doctors and nurses would be singing and dancing in the halls.”

I was mystified. “Who did the research?”

“How should I know? You work here,” Carver snapped, his eyes grim.

I had heard nothing that merited network news and replied lamely, “Mr. Carver, I wish I knew more about the story so I could tell you what the discovery meant. Sometimes advances reported in the news are preliminary, and, while we hope they're a breakthrough, it's usually too early to tell.”

Carver glared at me. “You're lying. What are you trying to hide?”

I flinched. “Look, Mr. Carver, I'll find out about the story and let you know as soon as I can.”

Carver was breathing rapidly. His pulse raced and throbbed in his neck.

“Let me help you,” I said as I moved toward him.

Carver waved me away. “Don't touch me,” he said angrily and pushed the call button for the nurse.

A sturdy middle-aged nurse named Lavonne arrived almost immediately. As I left the room, I could hear Carver's panting mixed with Lavonne's litany. “You'll be fine, Mr. Carver. You'll be fine,” Lavonne said soothingly.

It was 8:15 a.m. I hurried to my clinic in the hospital basement and worked nonstop until noon. Then, while eating a sandwich at the nurses' station, I called the public relations department. I asked for Jennifer Richman and was connected immediately.

“Dr. Norton, how are you?” Jennifer said pleasantly.

“I'm doing well, Jennifer. I need to know about a news story.”

“Is it something we originated?”

“I suspect so.” My voice was edgy.

It was about 2 years before this conversation that I had first met Jennifer. She had come to the medical center from a local TV station to bolster our PR effort. Shortly after her arrival, my chairman asked us to send her material for press releases. “She's first-rate and, besides, publicity is something we need more of,” he said at our department meeting.

I had published more than 200 articles but had never had a press release. When my research team had a paper accepted in the journal Heart, I sent a preprint to Jennifer. She came to my office to interview me, and, as I described the experiments to be published in Heart, she made careful notes. The work was very clever. We had reconfigured rat genes so that the hearts bulged to three times the normal size. The pictures of the hearts were dramatic and would make the journal cover.

When I finished talking, Jennifer said earnestly, “I'm sure that this research will someday help people.”

“Any application to patients is a long way off,” I said, shaking my head. “Our study points primarily to a type of regulation that couldn't be detected before gene manipulation.”

“Dr. Norton, I know this work is very important. I think that the media will be very interested and that we can present it in a way a lay person can appreciate.”

“You're welcome to try,” I said reluctantly. Jennifer stood up and shook my hand firmly, but as she walked away, I felt uneasy.

Jennifer faxed me a draft of a press release. After some tinkering with the wording, it was sent all over the country. The next few weeks were frantic. Although I had left instructions to contact me for any inquiries about the press release, I never heard from Jennifer or any reporters. The morning after I returned from a West Coast trip, I went out to get the newspaper from my front lawn. I glanced at the front page and saw a headline large enough for a declaration of war: “Medical Center Doctors Find Heart Failure Cure.”

I was stunned and, as I read the story under a wire service byline, I felt outrage and dread.

Doctors at the University Medical Center have announced a new treatment for heart failure that will bring hope to millions. By putting new genes into weakened hearts, the doctors hope to get patients back to normal and leading active lives.

In an article in the journal Heart, a research team led by Dr. Eric Norton, Professor of Medicine and Chief of Cardiology, reported that genes for a protein called myosin can be produced in the heart muscle of rats and lead to a larger and stronger heart.

“We're very excited by these findings,” Norton said in an interview, “and are looking forward to trying this approach in patients.” Norton cautioned, however, that it may be several years before the insertion of genes into the hearts of patients is routine.

I could feel my face flush. I flung the paper in the air, ran back into the house to dress, and raced to the hospital.

As soon as I got to my office, I called Jennifer Richman.

“Did you see the newspaper today?” I asked, my voice straining.

“You were front page,” she said, sounding pleased.

“But the article is overblown. It's misleading. I didn't mention any treatment of heart failure.”

“But, you did, Dr. Norton. Here's the conclusion of your paper: ‘The in vivo cardiac insertion of genes with promoter elements active in other differentiated muscle tissues raises the possibility of a new approach to the treatment of cardiomyopathy.’ While you were away, a reporter called about the story. She wanted another angle to heighten reader interest. I couldn't reach you, so I helped her with some quotations and provided her this sentence. She made it the feature for the wire service.”

“But, that's just speculation,” I yelled.

“I'm sorry, Dr. Norton,” Jennifer said, almost apologetic. “In our business, your speculation is our news.” Her tone lifted, “Don't be upset. The story will run in at least 100 newspapers and probably on CNN. It will generate lots of interest in your work.”

I hung up, put my head on my desk, and prepared for the phone to ring.

That day I had more than 50 calls. By the end of the week, the number totaled 200. The question was always the same, “When can I get treated?” And to each caller, I gave the same rehearsed message: “While the research holds great promise, we do not yet have a trial for patients.”

My mail filled with letters from patients, each describing the misery of heart disease and pleading for a cure. As I dictated my responses, I felt totally drained. The flow of mail gradually dwindled, however, and my anger subsided. I stopped blaming myself for the press release and vowed never to send another story to Jennifer again, even if I scored at Nature.

Two years had passed from this episode until the day Carver confronted me. My own experience was vivid in my mind as I sat in a hospital basement and told Jennifer how Carver heard on Dan Rather about a cure for cancer.

“Your patient is probably mistaken, Dr. Norton,” Jennifer said, “There was nothing about us on the networks. But I can check the local affiliates.”

“Get back to me. I need to know by 5 p.m. That's when I make afternoon rounds.”

My afternoon clinic was quiet and, at 4:40, as I was writing my last note, my beeper went off. I pushed its button and saw Jennifer's number. I quickly reached her on the phone and asked anxiously, “Did you find the story?”

“I'm not certain.” she answered. “Yesterday, on a local station, in a story on cancer research, Tiffany Lewin—she's the health reporter for their news—ran an interview with George Ackerman. We had taped the interview ourselves and sent it to the station last month, to use anytime they wanted a medical story.”

“Ackerman is in immunology,” I said. “What's that have to do with cancer?”

“Ackerman studies the T-cell receptor. In the interview, he said that if scientists understand that molecule, they can figure out how the body's immune system recognizes cancer and develop new treatments to cure the disease.”

“I bet that's the story,” I said, suspecting that Carver in his fragmented state had been confused about the show.

“I hope we haven't caused you any trouble,” Jennifer said sincerely.

“No,” I said resignedly and hung up.

My clinic work complete, I walked slowly back to the ward, pondering what to say to Carver as Ackerman's work was not the breakthrough he had imagined. I didn't like my alternatives. If I lied, Carver might become angry that he had been denied treatment. If I told the truth, the reaction might be worse. Carver might lose all hope and withdraw even further.

As I entered Carver's room, I saw that the curtains were drawn around his bed and I could hear the gloomy rhythm of his breathing. Three breaths. Pause. Three breaths. Pause.

“Dr. Norton,” the voice came from behind the curtain.

“Mr. Carver?” I answered.

“Yes.”

I slowly opened the curtains. Carver was lying rigid under a single flannel blanket, his eyes covered by a cloudy film. His face looked masklike in the shadows of the room.

“Did you find out about the cure?” Carver's voice was thin and pitched like a woman's.

“Yes,” I said.

“Is it a breakthrough?”

“Yes.”

“A big one?”

“Yes.”

“Will it help people?”

“Yes.”

Carver paused as his eyes rose under his lids so that only the whites could be seen. His lips quivered but he said nothing.

I placed my hand on his. The skin was cool and bruised.

Carver opened his eyes for an instant as the edges of his mouth lifted into a graceful smile.

“Good,” he whispered and closed his eyes.

• Copyright ©2004 by the American College of Physicians