Strong Medicine

by Arthur Hailey

  Andrew’s mother, who had moved to Europe, was seldom heard from and, despite invitations, had never been to visit. She had not seen her grandchildren and apparently had no wish to. “When she hears from us, we remind her that she’s old,” Andrew observed. “She’d prefer not to have that happen, so I think we’ll leave her alone.”

  Celia sensed the sadness behind Andrew’s remark.

  Andrew’s long-estranged father had died; the news reached them, by merest chance, several months after it happened.

  As to younger family members, Lisa was now seven and in second grade at school. She continued to exhibit a strong personality, took her schoolwork seriously, and had a special pride in her growing vocabulary, though sometimes straining it. Referring to an American history lesson, she told Celia, “We learned about the American Constipation, Mommy,” and on another occasion when explaining a circle, “The outside is the encumbrance.”

  Bruce—now almost five—showed, in contrast, a gentleness and sensitivity, partly offset by a droll sense of humor. Celia was prompted to observe once to Andrew, “Brucie can be hurt easily. He’ll need more protecting than Lisa.”

  “Then he must do what I did,” Andrew responded, “and marry a strong, good woman.” He said it tenderly and Celia went to him and hugged him.

  Afterward she said, “I see a lot of you in Brucie.”

  Of course, the two of them bickered occasionally, and there had been a serious quarrel or two during eight years of marriage, but no more than was normal between husbands and wives, nor did the minor wounds they inflicted fail to heal quickly. Both knew they had a good marriage and did all they could to protect and preserve it.

  The children were with them when they watched, on TV, the rioting in Watts.

  “My God!” Andrew breathed, as scene followed awful scene—of burning, looting, destruction, brutality, injury and death, savage fighting between embittered blacks and beleaguered police in the wretched, degrading, segregated ghetto slum of Charcoal Alley. It was a living nightmare of poverty and misery the world ignored, except at moments like this when Watts obligingly provided drama for the TV networks, which it would continue to do for five more dreadful days and nights. “My God!” Andrew repeated. “Can you believe this is happening in our own country?”

  All of them were so riveted to the TV screen that not until near the end did Celia observe Bruce who was shaking, quivering, sobbing silently, with tears streaming down his face. She went to him at once and held him, urging Andrew, “Switch it off!”

  But Bruce called out, “No, Daddy! No!” and they continued watching until the terrible scenes were done.

  “They were hurting people, Mommy!” Bruce protested afterward.

  Still comforting him, Celia answered, “Yes, Brucie, they were. It’s sad and it’s wrong, but it sometimes happens.” She hesitated, then added, “What you’re going to find out is that things like what you saw often happen.”

  Later, when the children were abed, Andrew said, “It was all depressing, but you gave Brucie the right answer. Too many of us live in cocoons. Sooner or later he has to learn there’s another world outside.”

  “Yes,” Celia said. She went on thoughtfully, “I’ve been wanting to talk to you about cocoons. I think I’ve been in one myself.”

  A swift smile crossed her husband’s face, then disappeared. He asked, “Could it be an O-T-C cocoon?”

  “Something like that. I know that some of what I’ve been doing involves things you don’t approve of, Andrew—like Healthotherm and System 500. You haven’t said a lot. Have you minded very much?”

  “Maybe a little.” He hesitated, then went on. “I’m proud of you, Celia, and what you do, and it’s the reason I’ll be glad when someday you go back to the prescription medicines side of Felding-Roth, which we both know is a whole lot more important. Meanwhile, though, there are things I’ve come to terms with. One is, people will go on buying snake oil whether you or others produce it, so it doesn’t make a helluva difference who does. And something else: If people didn’t buy O-T-C potions and went to doctors instead, we’d all be swamped—we couldn’t cope.”

  “Aren’t you rationalizing?” Celia asked doubtfully. “Just because it’s me?”

  “If I am, why not? You’re my wife, and I love you.”

  “That goes both ways.” She leaned over to kiss him. “Well, you can stop rationalizing, darling, because I’ve decided that O-T-C and I have been together long enough. Tomorrow I intend to ask for a change.”

  “If it’s what you really want, I hope you get it.”

  But Andrew’s response was reflexive, automatic. The mental depression produced by the televised scenes from Watts had stayed with him. So had a crucial personal problem, not related to Celia or his family—a problem that had already caused him anguish and would not, could not go away.

  “The dilemma is,” Sam Hawthorne told Celia next day, “you’ve been too successful—or, rather, far more successful than anyone expected. You are a goose producing golden eggs, which is why you’ve been left alone at Bray & Commonwealth.”

  They were in Sam’s office at Felding-Roth headquarters—a meeting arranged at Celia’s request and at which she had just asked for a transfer from her O-T-C duties.

  “I have something here which may interest you,” Sam said. Reaching across his desk, he shuffled several file folders, pulled one free from the others and opened it. From the other side of the desk Celia could see that it contained financial statements.

  “This hasn’t been circulated yet, but the board of directors will see it soon.” Sam put his finger on a figure. “When you went over to Bray & Commonwealth, revenues from that division were ten percent of all Felding-Roth sales. This year the figure will be fifteen percent, with profit up proportionately.” Sam closed the folder and smiled. “Of course, you were helped a little by a falloff in prescription drugs sales. Just the same, it’s a tremendous achievement, Celia. Congratulations!”

  “Thank you.” Celia was pleased. She had expected the figures to be favorable, though not as outstanding as those Sam had just reported. She considered briefly, then told him, “I think O-T-C will keep its momentum, and Bill Ingram has become very good. Since, as you just said, prescription sales are down, maybe I could help out there.”

  “You will,” Sam said. “I promise it. Also, we may have something special and interesting for you. But be patient for a few months more.”

  3

  Andrew faced the hospital administrator grimly. They were in Leonard Sweeting’s office and both were standing. Tension hung in the air between them.

  It was a Friday, close to noon.

  “Dr. Jordan,” the St. Bede’s administrator said formally—his voice taut, his expression serious—“before you go any further, let me caution you to be absolutely certain of what you are saying and to consider the consequences which may follow.”

  “Goddammit!” Andrew, who was short-tempered from a sleepless night, was ready to explode. “Do you think I haven’t done that?”

  “I imagined you had. I wanted to be sure.” As usual, Sweeting’s thick, bushy eyebrows moved up and down rapidly as he spoke.

  “All right—here it is again, Leonard, and this time I’m making it official.” Continuing, Andrew chose his words carefully, the sentences wrenched reluctantly from his heart.

  “My partner, Dr. Noah Townsend,” Andrew said, “is up on the medical floor at this moment where he is seeing patients. To my personal knowledge, Dr. Townsend is under the influence of drugs, to which he is addicted. In my opinion he is incompetent to practice medicine and may be endangering patients’ lives. Further, also to my personal knowledge, a patient died needlessly in this hospital this week because of an error by Noah Townsend when he was impaired by drugs.”

  “Jesus!” At the final sentence the administrator had paled. Now he pleaded, “Andrew, can you at least leave that last bit out?”

  “I can’t and I won’t! I also demand that you do somethi
ng immediately.” Andrew added savagely, “Something you should have done four years ago when we both knew what was happening, but you and others chose to keep your mouths closed and your eyes averted.”

  Leonard Sweeting growled, “I have to do something. Legally, after what you’ve told me, I have no choice. But as to what’s past, I know nothing about it.”

  “You’re lying,” Andrew said, “and both of us know it. But I’ll let that go because at the time I was as bad, and as gutless as you. What I’m concerned about is now.”

  The administrator sighed. He said, half to himself, “I guess this had to break open sometime.” Then, moving to his desk, he picked up a telephone.

  A secretary’s voice rattled in the instrument and Sweeting instructed, “Get me the chairman of the board downtown. Whatever he’s doing, tell his people to break into it. This is urgent. When you’ve done that, you and anyone else out there get on phones and summon a meeting of the medical executive committee. The meeting will be held immediately in the boardroom.” Sweeting glanced at a clock. “Most heads of services should be in the hospital now.”

  As the administrator put down the phone he grimaced wearily, then his manner softened. “This is a bad day, Andrew. For all of us, and for the hospital. But I know you’ve done what you felt you had to.”

  Andrew nodded dully. “What happens next?”

  “The executive committee will meet in a few minutes. You’ll be called in. Meanwhile wait here.”

  Somewhere outside a noontime whistle sounded.

  Time. Wait. Waiting.

  Andrew mused dejectedly: Waiting was what he had done too much of. He had waited too long. Waited until a patient—a young patient, who should have lived for many more years—had died.

  After his discovery, four years and eight months earlier, that Noah Townsend was a drug addict, Andrew had kept watch as best he could on the older physician—the objective being to ensure that no medical mishap or crucial misjudgment occurred. And while there were limits, obviously, to the closeness of Andrew’s scrutiny, he was satisfied that no serious malpractice problem had existed.

  As if recognizing and accepting his colleague’s concern, Noah would often discuss his difficult cases, and it was evident that, drugs or not, the elderly doctor’s diagnostic skills were continuing to function.

  On the other hand, Dr. Townsend became noticeably more careless about taking drugs, not bothering with the concealment from Andrew he had practiced earlier, and showing increasing signs of the drugs’ effects—glazed eyes, slurred speech and shaky hands—both at the office and St. Bede’s. He left dozens of sample bottles of prescription drugs lying around in his office, not even taking the trouble to put them out of sight, and he would dip into them—occasionally when Andrew was with him—as if they contained candy.

  Sometimes Andrew wondered how Townsend could continue to be a drug addict, yet function as well as he appeared to. Then Andrew reasoned: habit died hard, and so did instincts. Noah had been practicing medicine for so many years that much of what he did—including diagnoses which could be difficult for others—came easily to him. In a way, Andrew thought, Noah was like a flawed machine which goes on running of its own momentum. But a question was: How long would the momentum last?

  Still, at St. Bede’s, no one else appeared to share Andrew’s concern. However, in 1961—a year after Andrew’s discovery about Noah and the first, abortive session with Leonard Sweeting—Noah Townsend did step down as chief of medicine, also quitting the hospital’s medical board. Whether the changes were Townsend’s own idea or the result of a quiet suggestion, Andrew never found out. Also, from then on, Townsend led a less active social life, staying at home more than in the past. And at the office he eased up on his patient load, mostly referring new patients to Andrew and a new young doctor, Oscar Aarons, who had joined their practice.

  From time to time Andrew still worried about Noah and patients, but because there seemed no major problem, Andrew had—as he saw it now—simply drifted along, doing nothing, waiting for something to happen, yet nurturing a wishful belief it never would.

  Until this week.

  The climax, when it came, arrived with shattering suddenness.

  At first Andrew had only partial, disconnected information. But soon afterward, because of his suspicions and inquiries, he was able to piece events together in their proper sequence.

  They began on Tuesday afternoon.

  A twenty-nine-year-old man, Kurt Wyrazik, appeared in Dr. Townsend’s office complaining of a sore throat, nausea, persistent coughing and feeling feverish. An examination showed his throat to be inflamed; temperature was 102 and respiration rapid. Through his stethoscope, Noah Townsend’s clinical notes revealed, he heard suppressed breath sounds, lung rales, and a pleural friction rub. He diagnosed pneumonia and instructed Wyrazik to go to St. Bede’s Hospital where he would be admitted immediately and where Townsend would see him again, later in the day.

  Wyrazik was not a new patient. He had been in the office several times before, beginning three years earlier. On that first occasion he had also had an inflamed throat and Townsend had given him, there and then, a shot of penicillin.

  In the days that followed the injection, Wyrazik’s throat returned to normal but he developed an itchy body rash. The rash indicated that he was hypersensitive to penicillin; therefore that particular drug should not be given him again because future side effects might be severe or even catastrophic. Dr. Townsend made a prominent, red-starred note of this in the patient’s medical record.

  Wyrazik had not, until that time, known about his allergy to penicillin.

  On a second occasion, when Wyrazik arrived with a minor ailment, Noah Townsend was away and Andrew saw him. Reading the patient’s file, Andrew observed the warning about penicillin. At that point it did not apply, since Andrew prescribed no medication.

  That—about a year and a half earlier—was the last time Andrew saw Wyrazik alive.

  After Noah Townsend sent Wyrazik to St. Bede’s, Wyrazik was installed in a hospital room where there were three other patients. Soon afterward he was given a normal workup by an intern who took a medical history. This was routine. One of the questions the intern asked was, “Are you allergic to anything?” Wyrazik replied, “Yes—to penicillin.” The question and answer were recorded on the patient’s hospital chart.

  Dr. Townsend kept his promise to see Wyrazik later at the hospital, but before that he telephoned St. Bede’s, instructing that the patient be given the drug erythromycin. The intern complied with the order. Since, with most patients, it was normal to use penicillin to treat pneumonia, it appeared that Townsend had either read the allergy warning in his file, or had remembered it—perhaps both.

  That same day, when he visited Wyrazik in the hospital, Townsend would have—or should have—read the intern’s notes, thus receiving a further reminder about the penicillin allergy.

  The patient’s own background had some relevance to what happened, or failed to happen, later.

  Kurt Wyrazik was a mild, unobtrusive person, unmarried and without close friends. Employed as a shipping clerk, he lived alone and was in every sense a “loner.” No one visited him while he was in the hospital. Wyrazik was American-born; his parents had been Polish immigrants. His mother was dead. His father lived in a small town in Kansas with Kurt’s older sister, also unmarried. The two were the only people in the world with whom Kurt Wyrazik had close ties. However, he did not inform them that he was ill and in St. Bede’s.

  Thus the situation remained until the second day of Wyrazik’s stay in the hospital.

  On the evening of that second day, around 8 P.M., he was seen again by Dr. Townsend. At this point also, Andrew had some indirect connection with the case.

  Noah Townsend, of late, had taken to visiting his hospital patients at unorthodox hours. As Andrew and others reasoned afterward, he may have done so to avoid meeting medical colleagues in the daytime, or it may have been his general disorientati
on due to drugs. It so happened that Andrew was also at St. Bede’s that evening, dealing with an emergency for which he had been called from home. Andrew was about to leave the hospital as Townsend arrived, and they spoke briefly.

  Andrew knew at once from Noah Townsend’s demeanor and speech that the older physician was under the influence of drugs and had probably taken some quite recently. Andrew hesitated but, since he had been living with the situation for so long, reasoned that nothing harmful would happen; therefore he did nothing. Later Andrew would blame himself bitterly for that omission.

  As Andrew drove away, Townsend took an elevator to the medical floor where he saw several patients. The young man, Wyrazik, was the last.

  What went on in Townsend’s mind at that point could only be guessed at. What was known was that Wyrazik’s condition, while not critical, had worsened slightly, with his temperature higher and breathing difficult. It seemed likely that Townsend, in his befuddled state, decided the earlier medication he had prescribed was not working and should be changed. He wrote out new orders and, leaving Wyrazik, delivered them personally to the nursing station.

  The new orders were for six hundred thousand units of penicillin every six hours, injected intramuscularly, with the first injection to be given at once.

  Because of the absence, through illness, of a senior nurse, the night nurse on duty was junior and new. She was also busy. Seeing nothing unusual in Dr. Townsend’s order, she carried it out promptly. She had not seen, nor did she read then, the earlier notes in the patient’s chart; hence she was unaware of the warning about penicillin allergy.

  Wyrazik himself, when the nurse reached him, was both feverish and sleepy. He did not ask what was being injected into him, nor did the nurse volunteer the information. Immediately after giving the injection the nurse left Wyrazik’s room.

  What happened next had to be partly conjecture; the other part was based on a report from another patient in the room.