Strong Medicine

by Arthur Hailey

Given the known effects of penicillin in the circumstances, Wyrazik would, within moments, have experienced severe apprehension accompanied by sudden itching all over his body, and his skin would have turned fiery red. In a continuing swift process he would have gone into anaphylactic shock with rapid swelling and distortion of his face, eyes, mouth, tongue and larynx, all accompanied by sounds of choking, wheezing and other desperate noises from the chest. The swelling of the larynx, most critical of all, would have blocked the airway to the lungs, preventing breathing, followed—mercifully, after pain and terror—by unconsciousness, then death. The entire process would occupy five minutes or perhaps a little more.

  If emergency treatment had been used, it would have consisted of a massive injection of adrenaline and an urgent tracheotomy—a surgical cut through the neck into the windpipe—to get air into the lungs. But it was never called for, and when help arrived it was too late.

  Another patient in the room, observing thrashing and hearing choking noises from the adjoining bed, pressed a bell push urgently to call back the nurse. But when she came Kurt Wyrazik had already died—unaided and alone.

  The nurse immediately paged a resident. She also paged Dr. Townsend in the hope that he was still in the hospital. He was, and arrived first.

  Townsend took charge, and again the reasoning behind his actions had to be conjectured.

  What seemed most likely was that a realization of what had happened penetrated his befuddled state and, with an effort of will, he cleared his head and began what—except for Andrew’s intervention later—would have been a successful cover-up. It must have been clear to him that the nurse did not know about the penicillin allergy. It was also possible that, with some extraordinary luck, the two incriminating items—the earlier entry on the patient’s chart concerning the allergy, and the penicillin injection—might not be connected. So if he could pass off the death as occurring from natural causes, the true cause might not attract attention. It also could not have escaped Townsend’s notice that Kurt Wyrazik was without close friends, the kind likely to ask prying questions.

  “Poor fellow!” Townsend told the nurse. “His heart gave out. I was afraid it might happen. He had a weak heart, you know.”

  “Yes, Doctor.” The young nurse was immediately relieved that she was not being blamed for anything. Also, even now, Noah Townsend was an impressive, seasoned figure of authority whose pronouncement she did not question. Nor was it questioned by the resident who had been called, and who returned to other duties after finding there was an “attending” on the scene; therefore he was not needed.

  Townsend sighed and addressed the nurse. “There are things we have to do after a death, young lady. Let’s you and me get on with them.”

  One of the things was to complete a death certificate in which Noah Townsend recorded the death as due to “acute heart failure secondary to pneumonia.”

  Andrew learned about Kurt Wyrazik’s death by chance on Thursday morning.

  Passing through the office reception area which he, Townsend, and Dr. Aarons shared, Andrew heard Peggy, the receptionist who had replaced the departed Violet Parsons, refer on the telephone to “Dr. Townsend’s patient who died last night.” Soon after, Andrew encountered Townsend and said sympathetically, “I hear you lost a patient.”

  The older man nodded. “Very sad. It was a young fellow; you saw him once for me. Wyrazik. He had a bad case of pneumonia, also a weak heart. His heart gave out. I was afraid it might.”

  Andrew might have thought no more about the matter; the death of a patient, while regrettable, was not unusual. But there was something awkward in Townsend’s manner which aroused a sense of vague disquiet. The feeling prompted Andrew, an hour or so later when Townsend had left the office, to pull out Wyrazik’s medical file and read it. Yes, now he remembered the patient and, going through the file, Andrew noticed two things. One was a notation about a penicillin allergy, which did not seem significant. The other was the absence of any reference to heart disease, which did.

  Still not overly concerned, but curious, Andrew decided to make discreet inquiries about Wyrazik’s death at the hospital later in the day.

  That afternoon he went to the records office at St. Bede’s. Wyrazik’s chart and other documents had been sent there from the medical floor after the patient’s death.

  Andrew read the last entry on the medical chart first—the cause of death, as recorded by Dr. Townsend—then worked backward through the file. Almost at once the order, in Townsend’s handwriting, for six hundred thousand units of penicillin leaped out at him, striking Andrew like a thunderbolt. Equally shattering was the nurse’s notation that the penicillin had been administered and, as time sequences showed, it was shortly before Wyrazik died.

  Andrew read the rest of the file—including the intern’s note about penicillin allergy and the earlier order for erythromycin—in a daze. When he returned the file to a records clerk his hand was shaking, his heart pounding.

  Questions hurled themselves. What to do? Where to go next?

  Andrew went to the morgue to view Wyrazik’s body.

  In death the eyes were closed, the dead man’s features composed. Except for a slight bluish, cyanotic tinge to the skin which could have been from other causes, there were no telltale signs of the anaphylactic shock which, Andrew now believed, had killed this young man needlessly.

  He asked the morgue attendant who accompanied him, “Has an autopsy been ordered?”

  “No, sir.” Then the man added, “There’s a sister who’s supposed to be coming from Kansas. There’s to be cremation after she gets here.”

  Andrew’s thoughts were in turmoil. Remembering his earlier experience with the hospital administrator, he was still uncertain about what to do next. Clearly, something must be done, but what? Should he sound a warning about the need for an autopsy? One thing Andrew was sure of: an autopsy would show there had been no heart failure. But even without an autopsy the entries on the patient’s chart were damning evidence.

  By now it was early evening, most senior people in the hospital had gone home, and there was little choice but to wait until next day.

  Throughout that night, while Celia slept beside him, unaware of her husband’s problem, he lay awake as courses of action chased themselves around his mind. Ought he to go before colleagues in the hospital with what he knew, or would impartial proceedings be more assured if he went to authorities outside? Should he confront Noah Townsend first and hear Noah’s explanation? But then Andrew realized the futility of this, as Noah’s personality had clearly changed, even more than appeared on the surface—the result of his drug addiction over years.

  The Noah Andrew had once known and respected, and at moments loved, was upright and honorable, holding the strongest views about ethics and medicine, so that he would never have condoned in himself or others the awful professional negligence, followed by subterfuge, which he had just practiced. The old Noah Townsend would have stood up, confessed and taken the consequences, no matter how harsh. No, a personal confrontation would accomplish nothing.

  Over it all, Andrew had a sense of great sadness and of loss.

  In the end he decided wearily that he would keep what he knew within the family of the hospital. If other, outside action needed to be taken, then others in the hospital must decide. Next morning in his office he took time to write a detailed summation of what he knew. Then, shortly before noon, he went to St. Bede’s and confronted the administrator.

  4

  If he closed his eyes, Andrew thought, he might well imagine he was at a PTA meeting at the children’s school, or perhaps in the boardroom of a nuts-and-bolts industrial company making everyday, routine decisions.

  The words flowed past him.

  “May I have a resolution on that?”

  “Mr. Chairman, I propose …”

  “Is there a seconder?”

  “… second that.”

  “… been proposed and seconded … Those in favor of the res
olution …”

  A chorus of “aye.”

  “Against?”

  Silence.

  “… declare the resolution carried. By unanimous decision the hospital privileges of Dr. Noah Townsend are suspended …”

  Could this truly be the way it happened? This prosaic, formal, minor-key accompaniment to deepest tragedy. Were these petty, pecksniffian phrases the best that could be found to signal the sudden, grievous ending of a lifetime’s work, a once dedicated man’s career?

  Andrew was not ashamed to find that tears were coursing down his face. Aware that others seated around the hospital boardroom table were watching, he made no attempt to hide them.

  “Dr. Jordan,” the chairman of the medical board executive committee said considerately, “please believe me that the rest of us share your great sadness. Noah was, and is, our friend and colleague too. We respect you for doing what you have, which we are well aware was difficult. What we have done was equally difficult, but equally necessary.”

  Andrew nodded, unable to speak.

  The chairman was Dr. Ezra Gould. He was a neurologist and the chief of medicine, having succeeded Noah Townsend in that office three years earlier. Gould was small and soft-spoken, but quietly strong and greatly respected at St. Bede’s. The others on the committee were heads of services—surgery, obstetrics and gynecology, pathology, pediatrics, radiology, several more. Andrew knew most of them fairly well. They were decent, sensitive, caring people, but doing what they had to, even though, in Andrew’s view, their action had been delayed too long.

  “Mr. Chairman,” Leonard Sweeting said, “I should inform the committee that in anticipation of its decision I prepared a notice which will go immediately to the entire hospital—nursing stations, admitting office, pharmacy, and so on. In it I took the liberty of describing Dr. Townsend’s suspension as being ’because of health reasons.’ I believe that’s more discreet than anything specific. Is that agreeable?”

  Gould glanced inquiringly at the others. There were murmurs of assent.

  “It’s agreeable,” Gould said.

  “I would also urge,” the administrator continued, “that the details of what has passed here be discussed outside this room as little as possible.”

  Leonard Sweeting had guided the committee on procedure from the moment the meeting’s purpose had been made known—to the shock and consternation of the senior doctors summoned here so hurriedly. Sweeting had also, before the meeting began, had a hurried telephone consultation with the hospital chairman, a veteran local lawyer, Fergus McNair, whose practice was in Morristown. The conversation had been in Andrew’s presence and, while hearing only one side of it, Andrew did catch the chairman’s emphatic final words which rattled in the phone receiver, “Protect the hospital.”

  “I’ll do my best,” the administrator had said.

  After that Sweeting had gone into the boardroom, which adjoined his office, closing the door behind him and leaving Andrew alone. In a few minutes the door reopened and Andrew was summoned in.

  All faces around the boardroom table were deadly serious.

  “Dr. Jordan,” the chairman, Dr. Gould, had said, “we have been informed of the nature of your charges. Please tell us what you know.”

  Andrew had repeated what he had told the administrator earlier, at times referring to his notes. Following his statement there were a few questions and some discussion, but not much. Leonard Sweeting then produced the hospital’s file on the deceased Kurt Wyrazik, which was passed around and the patient’s chart, with its damning entries, examined amid doleful head shaking.

  Andrew had the clear impression that although members of the committee had not expected today’s disclosures to unfold as they had, the subject itself was no surprise to them.

  The formal resolution had come next, stripping Noah Townsend of his long-held status at St. Bede’s.

  Now the chief of pediatrics, a gaunt, slow-speaking New Englander, said, “Something we haven’t discussed is what’s to happen concerning the young man who died.”

  “Knowing what we do,” the administrator answered, “it’s essential that an autopsy be performed. Just before this meeting I spoke by telephone with the deceased’s father in Kansas—a sister is on the way here—and the father has given the necessary permission. So the autopsy will be done today.” Sweeting glanced at the head of pathology, who signified assent.

  “All right,” the pediatrics chief persisted, “but what do we tell his family?”

  “Quite frankly,” Sweeting said, “because of the legal issues involved, that is a delicate, potentially volatile subject. I suggest you leave a decision on it to Dr. Gould, to me, and to Mr. McNair who will be here shortly and who will also advise us legally.” He added, “Perhaps, later on, we will report back to this committee.”

  Dr. Gould asked the others, “Is that all right?” There were nods of agreement and also, it seemed, a sense of relief.

  Perhaps. Andrew thought: it was the operative word. Perhaps … we will report back to this committee. And perhaps we won’t.

  What the hospital, in the persons of Leonard Sweeting and his boss Fergus McNair, would undoubtedly like was for everything to be hushed up, and for young Kurt Wyrazik, the innocent victim, to be cremated and forgotten. In a way, Andrew supposed, you couldn’t blame Sweeting or McNair. They had their responsibilities. And if all this came to a malpractice case in court, a jury award or financial settlement could be horrendous. Whether insurance would cover it, Andrew had no idea and didn’t care. The only thing he was sure of was that he would not be part of a cover-up himself.

  There had been a buzz of conversation and the chairman rapped a gavel for attention.

  “Now,” Dr. Gould said, “we come to the hardest part.” He glanced around the room. “I will have to go to Noah Townsend and tell him what has been decided here. I understand he is still in the hospital. Is there anyone who chooses to come with me?”

  Andrew said, “I’ll come with you.” It was, he thought, the very least that he could do. He owed that much to Noah.

  “Thank you, Andrew.” Gould nodded his appreciation.

  In the calm of later, quiet reflection, and despite the pathetic, strident scene that followed, Andrew had an instinct that Noah Townsend had been waiting for them and was relieved to see them come.

  As Dr. Ezra Gould and Andrew stepped out of an elevator on the medical floor, to their right were a busy corridor, patients’ rooms and a nursing station. At the end of the corridor Townsend was standing, doing nothing, appearing to be looking into space.

  As the two of them approached, he moved his head and then, observing them, seemed to shrink into himself. He turned away, but a moment later abruptly changed his mind. Swinging back, his features twisted in the parody of a smile, he held out his wrists, both close together.

  “Did you bring handcuffs?” Townsend asked.

  Gould seemed nonplused, then said, “Noah, I have to talk to you. Let’s go somewhere private.”

  “Why bother with privacy?” The response was close to a shout and it appeared as if Townsend had raised his voice deliberately; a nurse and several patients turned their heads in curiosity. “Isn’t the whole hospital going to know before the day is out?”

  “Very well,” Gould said quietly. “If you insist, we’ll do it here. It is my duty to tell you, Noah, that the medical board executive committee has held a meeting. With the greatest regret it was decided to suspend your hospital privileges.”

  “Do you have any idea”—Townsend’s voice was still raised—“how long I’ve been part of this hospital and how much I’ve done for it?”

  “I’m aware that it’s been many years and we all know you’ve done a great deal.” Gould was uncomfortably conscious of still more people listening. “Please, Noah, can’t we …”

  “Doesn’t all of that count for something?”

  “In this case, unfortunately no.”

  “Ask Andrew here how much I’ve done! Go on,
ask him!”

  “Noah,” Andrew said. “I told them about Wyrazik. I’m sorry, but I had to.”

  “Ah, yes! Wyrazik.” Townsend nodded several times with jerky movements of his head; he spoke more softly. “That poor young fellow. He deserved better. I’m sorry about Wyrazik too. I truly am.”

  Then suddenly, embarrassingly, the elderly physician broke down and began to blubber. Violent sobs shook his body. They were punctuated by incoherent phrases. “… first time … ever made mistake … surely overlooked … won’t happen … promise you …”

  Andrew reached for Townsend’s arm but Ezra Gould was ahead of him. Grasping it, Gould said firmly, “Noah, let’s get out of here. You’re not well. I’m going to take you home.”

  Still shaken by sobs, Townsend allowed himself to be eased toward the elevators. Curious glances followed them.

  Gould turned to Andrew. Pushing Townsend slightly ahead, the chief of medicine said quietly, “Andrew, stay here. Find out which patients Noah saw today and check any orders he may have written. Do it quickly. There must be no repetition of … You understand?”

  Andrew nodded. “Yes.”

  Reluctantly he watched the other two go.

  When they reached the elevators Townsend began screaming and shouting hysterically, trying to resist. Suddenly, incredibly, something within him seemed to have collapsed, reducing him to a shard of his former self, a broken figure, stripped of all dignity and stature. As an elevator door opened Gould shoved Townsend roughly, hurriedly inside. Even when the door closed the screaming could be heard. Then it faded as the elevator descended, leaving Andrew standing alone amid the silence.

  That evening, after dinner, Andrew received a telephone call at home from Ezra Gould.

  “I want to see you,” the chief of medicine said. “Tonight. Where would be most convenient? I’ll come to your house if you wish.”

  “No,” Andrew said. “Let’s make it at the hospital.” He had not felt equal yet to telling Celia about Noah and though, as she always did, Celia sensed something wrong, she had not pressed him for the reason.