Doctors

‘Do you think she knows how I feel, Brice?’ he asked.

  ‘I’m sure she does – to some extent. But then she probably tells herself she’s projecting it on you and that it’s all her imagination. That’s the only saving grace.’

  Barney shook his head.

  ‘Brice, I’m in trouble. I want to give up everything for her. I’m the only person on this goddamn earth who knows how wonderful and caring this girl is.’

  ‘She’s also beautiful,’ Brice commented. ‘I’ve seen her in the waiting room.’

  ‘Look,’ countered Barney forcefully, ‘I’ve seen “beautiful” in my day, I’m telling you that girl’s real beauty is inside.’

  He heard his intercom buzz. It was time for his next patient.

  Wiseman said, ‘Let’s talk about it later, Barn.’

  He walked back to his office, opened his door, and called in a new patient sent to him for consultation and evaluation. It was a man not much older than himself, although his inner torment made him pallid, and dark circles accentuated his eyes.

  ‘Mr Anthony?’ Barney asked.

  ‘Yes,’ the man replied as Barney closed the door, ‘I’m Doctor Anthony.’

  For the second time that day Barney was furious with himself. He’d read the patient’s whole history a dozen times the night before. But now he’d been so worked up about his own intemperate behavior that he had forgotten his new patient was presenting something he had never dealt with – a pathology that rapidly was turning into a clandestine epidemic.

  Anthony was classified as an ‘impaired physician.’ Or what some psychiatrists had come to call a ‘wounded healer.’

  They sat facing each other across Barney’s desk. And Barney resorted to the usual preamble. ‘What brought you to me, Doctor?’

  ‘I’m in internal medicine,’ Anthony began. ‘I’ve got a wife and kids who love me, even though I see them less than I probably should. All in all, I think I’m a pretty decent father – and a loving husband. What I mean is, Doctor, there is no external reason for me to be anything but satisfied with my whole life. I’m on the Board of the American Journal, and I get more referrals than I can handle …’

  Barney did not offer a comment. Or pose a question. Because at this point he had no idea what could possibly be lacking in this doctor’s world.

  ‘I like my patients,’ Anthony continued. ‘I’m devoted to them, really. When they’re in the hospital I visit every morning – and if possible before they go to sleep.’

  ‘That must be stressful,’ Barney offered. ‘I mean, especially with the terminally ill.’

  The physician nodded. ‘I’m afraid I carry all their problems around with me. And to be honest, I’ve – well – needed a sort of crutch to get me through the day.’

  He paused and then said with embarrassment, ‘I take a lot of tranquilizers.’

  Barney nodded understandingly. ‘Which you’ve prescribed for yourself?’

  ‘I need them, Doctor,’ Anthony replied. ‘Look at the broader picture. Each of my patients has a family – who share the stress of their illness with them. Multiply that by a dozen – no, by twenty – and you’ll get some notion why I need … comfort now and then.’

  He then continued apologetically, ‘I’m not a drinker, I’ve got self-control. But I do need a little Valium to get me through the day. I mean, it’s for my patients’ sake.’

  ‘How much do you take?’ asked Barney quietly.

  ‘Well,’ he answered hesitatingly, ‘ten milligrams—’

  ‘How often?’

  ‘A few times a day,’ the doctor replied evasively and looked at Barney, whose expression communicated that the answer was unsatisfactory.

  ‘Well, I would say my average intake in a day is about fifty to sixty mils.’

  ‘The normal maximum dosage is forty,’ Barney commented quietly.

  ‘Yes, I know.’

  ‘And since it acts as a central nervous system depressant, by now it’s probably having a paradoxical effect on you.’

  ‘No, no,’ Anthony protested, ‘I’ve been fine. I mean, I know the dosage’s high, but I’ve been functioning okay.’

  Suddenly, he slammed the desk and shouted, ‘I’m a good doctor, dammit!’

  Barney waited a moment and then asked gently, ‘You still haven’t answered my question. Doctor Anthony. What brings you here?’

  ‘I’m here,’ he said with difficulty, ‘for reasons that I still can’t understand. Last Sunday – no, two weeks ago – when my wife was at her mother’s with the kids—’ He paused and then finally encapsulated his trauma in five words. ‘I tried to kill myself.’

  ‘Barney, I’ll be honest with you, I’m in love with all my patients.’

  ‘Very funny, Castellano. Be serious. I’m really in a bind.’

  ‘Barney, you knew this could happen. It’s an occupational risk in your specialty. Don’t you think other caring doctors go through hell?’

  Her words recalled to Barney that there were physicians who had far more anguished souls than his. And he mentioned Dr Anthony to Laura – though not by name.

  ‘What’s bothering the guy?’ Laura asked sympathetically.

  ‘You won’t believe this, Laura, but his problem is he cares too much. I’m just beginning to discover that it’s like a special form of cancer that’s restricted to the good physicians. Some of them put armor plating on their feelings and treat their patients like a butcher treats his meat. And when I see a poor sensitive bastard like this suicidal doctor, I can’t say I blame the others. It’s self-preservation.’

  ‘I suppose you’re right,’ she conceded. ‘If I let go and grieved for every little preemie that I lost, I think I’d crack. In fact, I probably will sooner or later.’

  ‘Laura,’ Barney said with genuine concern, ‘I’ve told you and told you and told you, you should be talking to someone.’

  ‘C’mon, Barn, you know I’m okay. I really am.’

  ‘Oh yeah? Tell me the truth. How much Valium do you need to get through the day?’

  She hesitated and then evasively conceded, ‘Not that much. I’ve got things under control.’

  Oh Jesus, Barney thought, I wish I hadn’t brought it up.

  In retrospect, the Watergate scandal seemed to have whetted the media’s appetite for circus antics in the center ring of government. The public seemed to crave the live excitement of another Congressional investigation. But Gerald Ford was too damn decent to give anybody food for gossip.

  Though in a sense politics has always been theater, now it had become a spectator sport as well. And at last there was a promising middleweight bout on the horizon.

  By 1972 the Department of Health had succeeded in banning cigarette advertising on television – and made the manufacturers put warnings on each package that what purchasers were about to smoke might possibly be harmful to their health.

  Now, two years later, government health officials needed to go further. They were most concerned at this point with the damage done to unborn babies whose mothers smoked. Government health officials wanted the public to be aware that an uninformed mother might be puffing her own child’s life away.

  The tobacco industry was, of course, prepared. Indeed, their forces were always on alert, ready to attack as soon as the first match was lit. By contrast, the busy Senators and Representatives who sat on the Joint Health Committee had to rely on their assistants’ briefings to confront their single-minded, better-rehearsed adversaries. Besides, some of them were from states whose principal income was derived from tobacco.

  Capitol Hill veterans of the earlier clash sat in skull sessions with their advisors, thinking of a more exciting way to present the facts – which themselves were frightening, but would be buried by the suave rhetoric of the opposition.

  One junior Senator put forth the idea that they call as witnesses mothers who had lost children as a direct result of their heavy smoking.

  ‘That idea won’t fly, Richard,’ said their chairman, Tom Otis (D
-Minn), ‘the industry’s lawyers will smart-talk those poor gals into inarticulate wrecks. That’s the physician’s province. We need some big-league doctors who can talk in words of less than six syllables.’

  ‘Did you have anyone in mind, Senator?’ added the junior man.

  ‘Absolutely,’ Otis answered. ‘I’m surprised that you, as a young father, didn’t come up with it first: the most famous baby doctor in the world – Benjamin Spock.’

  There was an antiphonal buzzing in the meeting room: ‘No, no, no,’ clashing with ‘Good, good, good.’

  ‘With due respect, sir,’ said the junior Senator, voicing the opinion of all the hawks among them, ‘Spock’s still too political. He’s too identified with all those Vietnam protests.’

  A Republican Senator agreed. ‘He’s right, Tom. Spock’s too damn controversial.’

  ‘Goddamn,’ conceded Otis. ‘I’m afraid you’re right. What say we adjourn till nine tomorrow and meanwhile call our contacts in the AMA to see what suggestions they come up with.’

  That very evening Senator and Mrs Otis attended a small dinner party at the home of socialite Anne Harding. Also present was the bureau chief of Time, his wife, and a young Kissinger assistant, who was partnered with Dr Laura Castellano of the NIH. Otis, as he told his colleagues next morning, considered it ‘sheer dumb luck.’

  For this doctor was a pediatrician specializing in illnesses of new-born children.

  ‘And she was so in touch with the whole subject.’

  ‘Again, with due respect, Senator,’ Congressman Richard Moody tactfully dissented, ‘Dr Castellano isn’t what you might call well-known beyond the city limits.’

  Tom Otis fixed the younger lawmaker in his gaze and said, ‘My boy, I would think even a freshman like yourself would know the power of the media. Just by putting this gal on, she ipso facto becomes known.’

  Although a debate on cigarette package warnings is hardly as big a draw as the peccadilloes of a President, there were nearly four million spectators watching PBS that morning. Some had a vested interest. Wall Street traders had their little Sonys tuned to see if any unexpected bombshell might affect the value of tobacco stocks.

  There were also a few aficionados of the English language who reveled in the brilliant use of words that was the trademark of the spokesman for the industry, M. Arnold West (often mocked by his detractors as ‘M. Arnold South’).

  As always, his argument was neat and simple. The issue was not whether smoking was harmful – for this, he said, was a matter that only qualified scientists can determine – but of civil rights … It was a familiar but effective ploy, to tie the tainted object to a sacred cow and thus protect it by association.

  ‘It is also a matter of free enterprise,’ West continued, using more patriotic buzzwords. ‘For after all, we know that drunken drivers kill or maim innumerable innocents in tragic accidents all over this great land. But has anyone yet suggested that the breweries put warnings on their labels that their beverage might indirectly cause injury to others?

  ‘Now to the point before us: that the tobacco industry should warn that “smoking by pregnant mothers may cause birth defects or stillbirths.”’

  He paused to scan the faces around him to assess if he was reaching them, and then continued.

  ‘I’d like our distinguished Senators and Representatives, as well as all our visitors in the gallery, to look first to their left and then to their right.’ And he then urged them, ‘Go on, go on.’ The audience – at least in the gallery – were somewhat puzzled but did what they were told.

  ‘And now,’ said West, ‘I ask you. Does your neighbor look crippled? Does the person next to you look sick? Or – I know this is ridiculous – “Brain damaged”?’

  The advocate picked up the ball. ‘My point, distinguished members of Congress, ladies and gentlemen, is that it is statistically impossible that all those in this room, who, thank the Lord, are hale and hearty, were born of mothers who were nonsmokers. That is a statistical impossibility, and I defy – nay, I invite – a refutation of this point.’

  The murmurs from the gallery suggested his sophistry had won this round. He ended in impassioned peroration:

  ‘All we ask for is our civil rights. Let us be free. Let us be free to earn a living – and here I speak not only for smokers but for thousands upon thousands of our citizens who till the soil. Let us not allow a small hysterical minority to impinge upon the liberties our Founding Fathers fought for when they forged this nation.’

  He turned to the chairman and said, ‘Senator Otis, sir, that is all I have to say for now. I would be happy to answer any questions your committee might have.’

  ‘Thank you, Mr West,’ the lawmaker replied. ‘But since this isn’t a trial, let’s postpone the questions till we’ve heard from the supporters of this proposition. And, quite candidly, I count myself among them. We believe this is a medical issue and so we should like to call on expert witnesses.’ He looked down to his left and said, ‘Would you take the microphone please, Dr Castellano.’

  All eyes and the electronic cyclopean stare of the television camera focused on Laura.

  The director of the broadcast knew a good shot when he saw one and communicated to the cameraman’s earphone, ‘Stay tight on the broad’s face and just let Otis’s questions play voice-over.’

  Laura stated her name, her educational background, and her current position. Her A.B. and M.D. from Harvard may have especially pleased the Eastern viewers, but her current position as Research Fellow at NIH, trying to improve the fate of newborn babies, touched the nation.

  Moreover, Laura had come prepared, and not just with data and key phrases on blue index cards. She had brought to that hearing what all the eloquence and fire of Mr Arnold West could never have produced – photographs.

  (‘Castellano, you’ve gotta remember that it’s a visual medium,’ Barney had warned as they discussed her forthcoming appearance long into the night. ‘You’ve got pictures of the damaged lungs of babies, those little break-your-heart preemies struggling to breathe inside their isolettes – and be sure to get enlargements big enough for TV cameras to pick up. There’s nothing more eloquent than the sight of a sick little child.’)

  And so for once the dominant impression left by Laura Castellano was not merely that of a willowy blond beauty, but of a doctor explaining what the terrible pictures on the TV screen had meant.

  Mr West interrogated Laura relentlessly.

  ‘Ladies and gentlemen, as a father, I assure you that I am as touched as anyone in this room by the tragic pictures we have seen. But, with due respect, Miss Castellano – excuse me – or is it Mrs Castellano – or Ms? …’

  He had thereby conveyed to the spectators that the expert witness was not herself a mother. Of dubious bearing on the matter, but an emotionally solid hit.

  ‘You may call me Doctor Castellano, if you don’t mind,’ Laura said quietly.

  ‘Excuse me, Doctor Castellano, but you have not given us documentation that these poor unfortunate babies were brought to their sad condition because their mothers smoked. Is it not true that literally thousands of such babies are born every day, even to nonsmokers?’

  ‘Yes, sir.’

  ‘You did say it could happen even to nonsmokers?’

  ‘Yes, sir, I did.’

  ‘I think I’ve made my point,’ Mr West said, and sat back from his microphone.

  ‘Now I’d like to finish mine,’ said Laura. ‘This isn’t show business, Mr West. This is medical science. We don’t have stunt men or doubles or stand-ins. We don’t retouch our pictures to make patients look more sickly.’ And then she raised her voice. ‘Let me give you some hard facts: Babies born to women who smoke tend to be two hundred grams lighter than babies born to nonsmokers.

  ‘When a pregnant woman smokes, she inhales various poisons – not just nicotine, but carbon monoxide. Most of this crosses the placenta and reaches the baby.’

  She paused and then directed her
next question to the tobacco advocate himself. ‘I ask you, Mr West, would you put any child of yours near the exhaust pipe of a car even for a second – much less nine months?’

  There were murmurs in the hearing room. Across the land, viewers leaned forward in their seats.

  ‘I realize the Committee’s time is precious, but let me cite one more bit of information: With every cigarette she smokes, a pregnant woman directly increases her chances of having a stillborn baby.

  ‘I have photocopies of these data for every member of the Committee.’

  Game, Set, and Match to the Health Mafia.

  This time The Washington Post carried her picture. It was – as Laura had somewhat perversely hoped – a rather unflattering one, for she had scowled as she encountered the jostling swarm of paparazzi, urging her to ‘Look this way, Laura,’ and ‘Give us a smile, please, Dr Castellano.’

  She and Barney had a postmortem session late that night.

  ‘You did good, kid,’ he enthused. ‘Just don’t let this go to your head. I don’t want you posing for Playboy.’

  She laughed. ‘Let me tell you, Barney, I was really scared. That West is brilliant. I had no idea where he would be coming from in the question period. I hate to say this, but if I ever got sued for malpractice, I’d want that barracuda on my side.’

  ‘I only wish there was some way I could’ve filmed you today. I was really proud.’

  ‘Barney,’ she said softly, ‘almost every bull’s-eye that I made was an idea of yours.’

  ‘Aha, Castellano, my stopwatch shows you have actually been free from low self-esteem for almost twelve hours – that must be a record, huh?’

  She did not reply.

  ‘Laura, for God’s sake, I didn’t write your application to NIH, I didn’t write those papers that you’re publishing. You may recall, you were the one that got the A in Pfeifer’s course. When will you get it into your head that you’re terrific?’

  ‘Come on, Barn, don’t be ridiculous. So far my greatest achievement in life is being five-foot-ten and blond.’

  ‘You know something, Castellano, they’ve got this new operation out in California that can reduce height. I think I’ll treat you to five-foot-five for Christmas.’