The Case of the Invisible Line

CONNIE (V.O.)Sixty people put their hand up. Nine of them made it through the door.

I was the one who was supposed to notice the difference.

— music sting —

ANNOUNCERAdverse Events. From the case files of Dr. Tracy Grant, who writes the protocol, and Connie Chase, who makes it happen.

ANNOUNCERThe story you are about to hear is fiction. Any resemblance to your last study is purely coincidental and entirely predictable.

ANNOUNCERThe Case of the Invisible Line.

SCENE ONE — A CORRIDOR, THEN THE STREET

a photocopier running · tape torn off a roll · footsteps on hard floor

CONNIE (V.O.)The ASCEND trial. Nobody could ever tell you what it stood for, including the three of us who made it up.

Sixty participants in eleven weeks. That part of the job I'm good at.

The flyer took nine weeks and three offices to approve. Legal wanted a disclaimer. Somebody in communications wanted the logo bigger. The IRB wanted to discuss it for another month.

I spent a good part of those nine weeks on hold.

a handset lifted · a number dialled

RECORDED VOICEThank you for calling the Institutional Review Board. Your call is important to us. Current response time for expedited review is six to eight weeks.

handset down

CONNIE (V.O.)We ended up with five tear-off tabs and a QR code smaller than a postage stamp.

tape · a flyer smoothed flat against a wall

I put it up anyway. Grocery store, two clinics, the laundromat on Ash.

And it worked. That's the part nobody warns you about. Sometimes the thing works.

Sixty submissions in three weeks. Sixty people who read eleven paragraphs about their own sleep and thought: sure. I'll give you twelve weeks of my life for a twenty-five dollar gift card and the tax paperwork it generates.

a desk phone rings · handset lifted

CONNIERecruitment, this is Connie.

a voice on the line — warm, indistinct, never words

CONNIEYou did, yes. You're number thirty-one. (beat) No, that's not a ranking. That's just the order they came in.

the voice again, longer

CONNIESomebody will be in touch. I promise.

handset down

CONNIE (V.O.)She had a good question. She wanted to know whether it would still help if she couldn't manage all twelve weeks.

Most people ask about the money. She asked about the science.

— music bridge, four bars, then under —

SCENE TWO — THE OFFICE

no copier · fluorescent hum · a wall clock, audible now that nothing else is

CONNIE (V.O.)Eleven weeks later I sat down to draw the flow diagram.

If you've never had the pleasure — it's a column of boxes running down a page, and every single person who ever touched your study has to end up inside one of them. Assessed. Excluded. Consented. Analyzed.

It's the most honest document in research. Nobody gets rounded off.

Sixty assessed.

Nine consented.

Which put fifty-one people in a box marked Excluded.

the clock · nothing else

Holy mackerel. Fifty-one? In a sixty-person study?

I counted it twice. It came out fifty-one both times.

And under that box there's a line where you write the reason.

I sat there with a pen for a while, like the line was going to fill itself in if I stared at it long enough.

— music bridge, two bars —

SCENE THREE — THE SAME ROOM, LATER

the same hum, the same clock · a filing drawer

CONNIE (V.O.)Fifty-one people don't just get up and sneak away. Somebody let them walk.

Three suspects immediately appeared.

Time to line them up and make a positive identification.

First up: the flyer.

Wrong neighborhoods? Wrong wording? A QR code nobody on this earth could scan?

Great questions, and all the wrong answers.

Sixty witnesses, and every one of them swore that flyer did its job.

a drawer rolls open · folders pushed aside

Next up: eligibility. Maybe we'd built a study nobody alive could get into. It's been done before.

So I pulled the screening records.

Let's see here... Four ineligible. Two medications. One birthday. And a gentleman who lived in Nevada.

Four reasons I could write on the line. And forty-seven I couldn't.

a chair creaks

Which left yours truly. Did I turn left at some point when I shoulda turned right?

I keep a call log. People laugh at that log right up until it's the only thing standing between them and a very long meeting.

Every Thursday. Two hours. Eleven weeks, eleven Thursdays, not one of them missed. Ninety-four calls made and every one of them written down.

I went through it twice looking for the place I dropped the ball.

Came up clean.

But that's the worst news you can get. Because if it wasn't me, somewhere out there, there's a criminal on the loose.

papers squared against the desk

But the truth was there was one number left on the board, and I'd been giving it the cold shoulder since six.

Of the fifty-one, nearly every one was logged the same way. Not rejected. Not withdrawn.

But simply as No response.

"No response" hands you a shovel and paints an X on the ground.

I dug there till nine. Good plan, good shovel.

Wrong X.

— music bridge, two bars —

SCENE FOUR — THE TURN

CONNIE (V.O.)It was the phone call that did it. Not a new one. The one from March — number thirty-one, and her question about the twelve weeks.

I went to find her file, to see what we'd told her.

a folder opened · a single sheet drawn out

We had never told her anything. Not once. In four months.

So I did the only thing left. I took the list apart.

sixty sheets of paper set down one at a time

Sixty names, and ninety-four calls in the log. So I laid the log out beside the list and went looking for who I'd been spending my Thursdays on.

And there it was, in a shape you could see from the other side of the room.

Ninety-four calls. Nine people.

hold — the hum, the clock

Because the nine were the ones with dates on them.

Every person I got through to turned into a screening appointment, and a consent visit, and a rescheduled consent visit, and a reminder the day before. Somebody has to make those calls and that somebody is me.

They're on a calendar. They have a time. Miss one and a room sits empty and a person takes an afternoon off work for nothing.

And the woman who filled in a card in March and has heard nothing since?

She's not a no-show. No-shows have appointments. She's not a dropout. You have to be invited into a thing before you can drop out of it. She isn't even a protocol deviation, because no protocol ever written has a line on it for the person you simply never call.

So she waits. And the longer she waits, the quieter she gets.

Fifty-one people, and not one of them ever did a single thing to get my attention — because doing nothing is exactly what waiting looks like.

They weren't ignoring us. Nobody had asked them yet.

I guess we always knew how many people were waiting for a response.

We never once knew for how long.

— music bridge, two bars —

SCENE FIVE — THE CALL

traffic through a window · a kettle somewhere

CONNIE (V.O.)I called number thirty-one first thing.

a number dialled · ring · ring · pickup

CONNIEIt's Connie, from the sleep study at the university. I'm calling about your application.

the voice — surprised, brief

CONNIEIn March. Yes. (beat) I know.

the voice — longer now

CONNIE (V.O.)She'd taken a second job in May. Evenings. Our visits were evenings.

CONNIEI understand. I do.

the voice — short

CONNIEYou didn't do anything wrong. You called us twice. That one's ours.

handset down · a long breath

CONNIE (V.O.)She'd asked whether it would still help if she could only manage a few of the twelve weeks.

In the end we didn't give her one.

paper · a pen

The fix isn't clever and it isn't free.

Two hours is what I get on a Thursday. From now on, the first thirty minutes go to whoever's been waiting longest — before I touch one single thing that has a date on it.

Nobody gave me those thirty minutes. They come out of the same two hours.

Which means some week a reminder doesn't go out, and a room sits empty, and somebody takes an afternoon off work for nothing.

I know exactly what that costs. I'm choosing it anyway.

That's the whole thing. No new system. No committee. No form. Just half an hour a week going to the people who don't know to ask for it.

And it still took me sixty sheets of paper and half a night to see something a machine could have told me in March.

footsteps · a knock at an open door

CONNIETracy. You got a minute?

TRACYAlways.

CONNIEI know what to do now. First half hour of every Thursday goes to whoever's been waiting longest.

TRACYThat sounds right.

CONNIEIt is right. I just can't do it.

a chair creaks

TRACY(beat) Why not.

CONNIEBecause nothing in this building can tell me who that is. I found it out with sixty sheets of paper and half a night, and next Thursday it'll be a different sixty sheets. And the Thursday after that.

That report you built after DRIFT. The one that says who's gone quiet.

TRACYWhat about it.

CONNIEIt only watches the people who started. I need the same thing pointed at the ones who haven't — and it has to say for how long.

a pause

TRACYHow long has the longest one been waiting?

CONNIESixteen weeks.

a chair pushed back

TRACYYou're kidding, right?

(beat) You're not kidding. Show me. I'll get us some coffee.

— music, under —

CONNIE (V.O.)We sat with it till seven.

The diagram took the last hour of that. Forty-seven lines, two words apiece.

Not contacted.

Number thirty-one had been waiting since March.

— music up —

ANNOUNCERThis has been The Case of the Invisible Line.

— music up —

ANNOUNCERDr. —— appeared as the Voice of the Institutional Review Board.

ANNOUNCERAdverse Events is brought to you by Software for Research. For those who love discovery more than data entry.

ANNOUNCERAnd even though Reviewer 2 recommends rejection without review whenever they hear us: this is Adverse Events.

— music out —