Carol's car pull up, then the door slam. A few minutes later there was a quiet knock at his door. He ignored it, thinking she'd guess he was asleep.
He wanted to be alone.
Jeffrey struggled with his deepening sense of guilt. Perhaps that was the worst part of having been convicted. By undermining his confidence, he again worried that maybe he had erred in administering the anesthesia that fateful day. Maybe he had used the wrong concentration. Maybe Patty Owen's death was his fault.
Hours slipped by as Jeffrey's preoccupied mind wrestled with a growing sense of his worthlessness. Everything that he'd ever done seemed stupid and pointless. He'd failed at everything from being an anesthesiologist to being a husband. He couldn't think of one thing that he'd succeeded at.
He'd even failed at making the basketball team in junior high school.
When the sun sagged down in the western sky and touched the horizon,
Jeffrey had the sense it was setting on his life. He thought that few people could realize the tremendous toll malpractice litigation took on a practicing physician's emotional and professional life, especially when there was no malpractice involved. Even if Jeffrey had won the case, he knew that his life would have been changed forever. The fact that he lost was that much more devastating. And it had nothing to do with money.
Jeffrey watched the sky change from warm reds to cold purple and silver, while the light ebbed and the day died. As he sat there in the gathering gloom, he suddenly had an idea. It wasn't entirely true that he was helpless. There was something he could do to affect his destiny. With the first sense of purpose in weeks, Jeffrey pushed himself out of the wing chair and went to the closet. From it he pulled his large black doctor's bag and put it on the bureau.
From the doctor's bag he retrieved two small bottles of Ringer's Lactate intravenous fluid as well as two infusion kits and one small scalp needle.
Then he took out two vials, one of succinyleholine, the other of morphine.
Using a syringe, he drew up 75 mg of the succinylcholine and squirted it into one of the Ringer's Lactate bottles. Then he drew up 75 mg of morphine, a walloping dose.
One of the benefits of being an anesthesiologist was that Jeffrey knew the most efficient way to commit suicide. Other doc-
tors didn't, though they tended to be more successful in their attempts than the general public. Some shot themselves, a messy method which, surprisingly enough, was not always effective. Others took overdoses, another method that often didn't yield the desired result. Too often the would-be suicides were caught in time to have their stomachs pumped. Other times the drugs injected were enough to bring on a coma but not death. Jeffrey shuddered at the haphazard consequences.
Jeffrey felt his depression lift slightly as he worked. It was heartening to have a goal. He took the painting that hung over the head of the bed down to use the hook to hang both IV bottles. He then sat down on the side of the bed and started the IV on the back of his left hand with the bottle containing only the Ringer's Lactate solution. He piggy-backed the bottle containing the succiny1choline onto the other, with only the thin blue stopcock separating him from its lethal contents.
Careful not to dislodge the IV, Jeffrey lay back on the bed. His plan was to inject the huge dose of morphine and then open the stopcock on the solution containing the succiny1choline. The morphine would send him to never-never-land long before the succiny1choline concentration paralyzed his respiratory system. Without a ventilator, he would die. It was as simple as that.
Gently, Jeffrey inserted the needle of the syringe containing the morphine into the IV port of the infusion line going into the vein on the back of his hand. Just as he was beginning to inject the narcotic, there was a soft knock on his door.
Jeffrey rolled his eyes. What a time for Carol to interrupt. He held off the injection but didn't respond to her knock, hoping she'd go away if she thought he was still asleep. Instead, she knocked louder, then louder still. "Jeffrey!" she called. "Jeffreyl I've made dinner."
There was a short silence that made Jeffrey think she'd given up. But then
Jeffrey heard the knob turn and the door rattle against the jamb.
"Jeffrey-are you all right?"
Jeffrey took a deep breath. He knew he had to say something or she might be concerned enough to force the door. The last thing he wanted was for her to come barging in and see the IV.
"I'm fine," Jeffrey called out at last.
"Then why didn't you answer me?" Carol demanded.
"I was asleep."
"Why is this door locked?" Carol asked.
"I guess I didn't want to be disturbed," Jeffrey replied with pointed irony.
"I've made dinner," Carol said.
"That's nice of you, but I'm still not hungry."
"I made veal chops, your favorite. I think you should eat."
"Please, Carol," Jeffrey said with exasperation. "I'm not hungry. 11
"Well, come eat for my sake. As a favor to me."
Fuming, Jeffrey set the syringe with the morphine on the night table and pulled out the IV. He went to the door and yanked it open, but not so far that Carol could see in. "Listen!" he snapped. "I told you earlier that I wasn't hungry then and I'm telling you that I'm not hungry now. I don't want to eat and I don't like you trying to make me feel guilty about it, understand?"
"Jeffrey, come on. I don't think you should be alone. Now I've gone to the trouble to shop for you and cook. The least you can do is come try it."
Jeffrey could see there would be no getting around her. When she'd made up her mind, she was not the type of person who could be easily dissuaded.
"All right," he said heavily. "All right."
"What's wrong with your hand?" Carol asked, noticing a drop of blood on the back of it.
"Nothing," Jeffrey said. "Nothing at all." He glanced at the back of his hand. Blood was oozing from the IV site. Frantically, he searched for an explanation.
"But it's bleeding."
"A paper cut," Jeffrey said. He was never good at fibbing. Then, with an irony only he could appreciate, he added, "I'll live. Believe me, I'll live. Look," he said, "I'll be down in a minute."
"Promise?" Carol said.
"I promise."
With Carol gone and the door relocked, Jeffrey removed the quarter-liter IV bottles and stored them in the back of his closet in his leather doctor's bag. He threw the wrappers from the infusion kits and the scalp needle into the wastebasket in the bathroom.
Carol had some sense of timing, he thought ruefully. Only as he packed away the medical paraphernalia did he realize how close he had come. He told himself he shouldn't give in to despair, at least not until all legal avenues had been exhausted. Until this recent turn of events, Jeffrey had never seriously enter tained thoughts of suicide. He was honestly baffled by the sui-
cides he knew of, though intellectually he could appreciate the depths of despair that might prompt it.
Oddly enough, or perhaps not so oddly, the only suicides he had known were other doctors who'd been pushed to the brink by motives not unlike
Jeffrey's. He recalled one friend in particular: Chris Everson. He couldn't remember exactly when Chris had died, but it had been within the last two years.
Chris had been a fellow anesthesiologist. Years before, he and Jeffrey had been residents together. Chris would have remembered the days when gung-ho residents warded off flu symptoms with Ringer's Lactate. What made thinking about Chris suddenly so poignant was the realization that he'd been sued for malpractice because one of his patients had had a terrible reaction to a local anesthetic during epidural anesthesia.
Jeffrey closed his eyes and tried to remember the details of the case. As best as he could recall, Chris's patient's heart had arrested as soon as
Chris put in the test dose of only 2 cc's. Although they had been able to get the heart beating again, the patient ended up quadriplegic and semicomatose. Within a week after the event, Chris had been sued along with
>
Valley Hospital and everyone else even remotely associated with the episode. The "deep pockets" strategy yet again.
But Chris never went to court. He committed suicide even before the discovery period had been completed. And even though the anesthesia procedure had been characterized as having been impeccable, the decision ultimately rendered found for the plaintiff. At the time, the settlement had been the largest award for malpractice in Massachusetts' history. But in the ensuing months, Jeffrey could think of -at least two awards that had topped it.
Jeffrey could distinctly remember his reaction when he'd heard of Chris's suicide. It had been one of complete disbelief. Back then, before Jeffrey's current involvement with the legal system, he'd had no idea what could have pushed Chris to do such an awful thing. Chris enjoyed a reputation as a superb anesthesiologist, a doctoes doctor, one of the best. He'd recently married a beautiful OR nurse who worked in Valley Hospital. He seemed to have everything going for him. And then the nightmare struck...
A soft knock brought Jeffrey back to the present. Carol was at the door again.
"Jeffrey!" she called. "Better come before it gets cold."
"I'm on my way."
Now that he knew too well what Chris had only begun to go through, Jeffrey wished he'd stayed in touch at the time. He could have been a better friend. And even after the man ended his life, all Jeffrey had done was attend the funeral. He had never even contacted Kelly, Chris's wife, even though at the funeral he'd promised himself he would do so.
Such behavior wasn't like Jeffrey, and he wondered why he'd acted so heartlessly. The only excuse he could think of was his need to repress the episode. The suicide of a colleague with whom Jeffrey could so easily identify was a fundamentally disturbing event. Perhaps facing it squarely would have been too great a challenge for him. It was the kind of personal examination that Jeffrey and doctors in general had been taught to avoid, labeling it "clinical detachment."
What a terrible waste, he thought as he remembered Chris the last time he'd seen him, before all the tragedy struck. And if Carol hadn't interrupted, mightn't there be others thinking the same thoughts with respect to him?
No, Jeffrey thought vehemently, suicide wasn't an option. Certainly not yet. Jeffrey hated to sound mawkish, but where there was life, there was hope. And what had happened in the aftermath of Chris's suicide? With Chris dead, there was no one to defend or clear his name. For all his despair and developing depression, Jeffrey still was enraged by a system and process that had managed to convict him when he had honestly done no wrong. Could he really rest until he'd done his best to clear his name?
Jeffrey got angry just thinking about his case. To the lawyers involved, even Randolph, all this might be business as usual, but not so to Jeffrey.
This was his life on the line. His career. Everything. The great irony was that the day of the Patty Owen tragedy, Jeffrey had done his utmost to do well by her. He'd only run the IV and taken the paregoric so he could perform the job for which he'd been trained. Dedication was what had motivated him, and this was how he'd been repaid.
If Jeffrey ever was able to return to medicine, he would be afraid of the long-lasting effects this case would have on any medical decisions he would ever make. What kind of care could people come to expect from doctors who were forced to work in the current malpractice milieu and who had to restrain their best instincts and second-guess their every step? How had such a system evolved? Jeffrey wondered. It certainly wasn't eliminating the few "bad" doctors, since they ironically rarely got sued.
What was happening was that a lot of good doctors were being destroyed.
As Jeffrey washed before descending to the kitchen, his mind dredged up another memory that he had unconsciously repressed. One of the best and most dedicated internists he'd ever met had killed himself five years ago on the same night he'd received a summons for malpractice. Shot himself through the mouth with a hunting rifle. He hadn't even waited for the discovery process to begin, much less the trial. At the time Jeffrey had been disturbingly mystified, since everyone, knew the suit had been baseless. In fact the doctor had, ironically, saved the man's life. Jeffrey now had some idea of the source of the man's despair.
Finished in the bathroom, Jeffrey returned to his bedroom and changed into clean slacks and shirt. Opening his door, he smelled the food Carol had prepared. He still wasn't hungry, but he'd make an effort. Pausing at the top of the stairs, he vowed to fight the depressive thoughts he was bound to experience until this current episode had run its course. With that commitment in mind he started for the kitchen.
TUESDAY,
MAY 16,1989
9:12 A.M.
Jeffrey woke up with a start and was amazed at the time. He'd first awakened around five A.M., surprised to find himself sitting in the wing chair by the window. Stiffly, he had removed his clothes and gotten into bed, thinking he would never be able to fall back asleep. But obviously he had.
He took a quick shower. Emerging from his room, he looked for Carol. Having recovered to an extent from the depressive depths of the previous day, he wanted some h1iman contact and a bit of sympathy. He hoped that Carol had not left for work without talking to him. He wanted to apologize for his lack of appreciation for her efforts the night before. It was a good thing, he now realized, that she'd interrupted him, and that she'd gotten him irritated. Unknowingly she'd saved him from committing suicide. For the first time in his life, getting angry had had a positive effect.
But Carol was long gone. A note was leaning against a shredded wheat box on the kitchen table. It said that she'd not wanted to disturb him since she was sure he needed rest. She had to get to work early. She hoped he'd understand.
Jeffrey filled a bowl with cereal and got the milk from the refrigerator.
He envied Carol her job. He wished he had a job to go to. It would keep his mind occupied if nothing else. He would have liked to have made himself useful. It might have helped his self-esteem. He'd never realized quite how much his work defined his persona.
Back in his room, Jeffrey disposed of the IV paraphernalia by wrapping it in old newspapers and carrying it out to the trash barrels in the garage.
He didn't want Carol to find it. He felt strange handling the material. It gave him a tremendous uneasiness to have been knowingly and voluntarily so close to death.
The idea of suicide had occurred to Jeffrey in the past, but always in a metaphorical context, and usually more as a retribution fantasy to get back at someone who he believed had wronged him in some emotional way, like when his girlfriend in the eighth grade had capriciously switched her affections to Jeffrey's best friend. But last night it had been different, and to think that he'd come within a hair's breadth of doing it made his legs feel weak.
Returning to the house, Jeffrey considered what effects his suicide would have had on his friends and family. It probably would have come as a relief to Carol. She wouldn't have had to go through with the divorce. He wondered if anyone would have missed him. Probably not...
"For Pete's sake," Jeffrey exclaimed, realizing the ridiculousness of this line of thought and remembering his vow to resist depressive thoughts.
Would his thinking thrive on his low selfesteem for the rest of his days?
But the subject of suicide was hard to shake from his mind. He wondered again about Chris Everson. Had his suicide been the product of an acute depression that had struck like a sudden storm, like Jeffrey had felt the night before? Or had he planned it for some time? Either way, his death was a terrible loss for everyone-his family, the public, even the profession of medicine.
Jeffrey stopped en route to his room and stared out the livingroom window with unseeing eyes. His situation was no less a waste. From the point of view of his productivity, the loss of his medical license and his going to prison was no less a waste than if he'd succeeded in committing suicide.
"Damn!" he shouted as he grabbed one of the pillows from the couch and punched it repeatedly wi
th his fist. "Damn, damn, damn!"
Jeffrey quickly wore himself out and replaced the pillow. Then he sat himself down dejectedly with his knees jutting up in front of him. He interwound his fingers and rested his elbows on his knees and tried to think of himself in prison. It was a horrid thought. What a travesty of justice! The malpractice stuff had been more than enough to seriously disrupt and alter his life, but this criminal nonsense was a quantum leap worse, like throwing salt into a mortal wound.
Jeffrey thought about his colleagues at the hospital and other physician friends. They had all been supportive at first, at least until the criminal indictment had been handed down. Then they had avoided Jeffrey as if he'd had some kind of infectious dis-
ease. Jeffrey felt isolated and alone. And more than anything, he felt angry.
..It's just not fair!" he said through clenched teeth.
Robin Cook 1982 - Harmful Intent Page 7