Strong Medicine

  It was during a November afternoon a month earlier—which Andrew now remembered as beginning for himself a time of agonized soul-searching—that unease and vague suspicion had turned to certainty.

  The way it happened was that Andrew wished to discuss their schedule of days off, days when he and Dr. Townsend covered for each other. After checking to be sure no patient was with his colleague, Andrew knocked lightly on Townsend’s office door and went in. It was something each of them was used to doing frequently.

  Townsend had his back to Andrew and swung around, startled, in his haste failing to conceal what was in the palm of his hand—a sizable pile of tablets and capsules. Even then Andrew might have thought nothing of it, except for the older man’s subsequent behavior. Townsend reddened with embarrassment, then with some bravado brought his hand to his mouth, shoved the pills inside and with a glass of water flushed them down.

  There was no way Townsend could ignore the significance of what Andrew had seen, but he attempted to make light of it. “So you caught me stoking up the furnace!… Well, I admit I do it now and then—been under a lot of pressure lately, as you know … But never let things get away from me … I’m an old-cowhand doctor, m’boy—know too much to ever lose control … A damn sight too much.” Townsend laughed, a laugh which sounded false. “So don’t worry, Andrew—I know where and when to stop.”

  The explanation did not convince Andrew. Even less convincing was the slurred speech, a slurring which suggested that the pills Noah Townsend had just ingested were not the first he had had that day.

  Andrew asked, with a sharpness he immediately regretted, “What were you taking?”

  Again the false laugh. “Oh, just a few Dexedrine, some Percodan, a touch of Darvon for added flavor … Andrew, what the hell does it matter?” Then, with a touch of belligerence, “Told you I keep it under control. Now, what did you come to see me about?”

  With his mind in a turmoil, Andrew mentioned the subject of days off—which now seemed absurdly unimportant—speedily settled what was necessary, and left Noah Townsend’s office as quickly as he could. He needed to be alone. To think.

  Andrew was horrified at the stew of drugs—there must have been a dozen or fifteen tablets and capsules—which his older colleague had casually downed. According to Noah’s own admission, they were stimulants and depressants—drugs which reacted to each other and which no competent doctor would prescribe in combination. While not an expert on addiction, Andrew knew enough to realize the quantity and casualness were hallmarks of someone who was a long way down the addict’s road. And prescription drugs taken indiscriminately, as Noah clearly was taking them, could be as dangerous and destroying as any street drug sold illegally.

  What to do next? The immediate thing, Andrew decided, was to find out more.

  Over the next two weeks he used whatever time he could spare to visit medical reference libraries. St. Bede’s had a modest one; Andrew knew of another in Newark. Both had cataloged reports about physicians who became drug addicts and, as he studied the material, the first thing to become evident was the common and widespread nature of the problem. The American Medical Association estimated that some five percent of all physicians were “impaired” because of drug abuse, alcoholism, or related causes. If the AMA admitted to that startling figure, Andrew reasoned, the real one must be higher. Others seemed to agree. Most estimates ranged to ten percent, several to fifteen.

  One conclusion reached by all observers was that doctors got into trouble because of overconfidence. They were convinced that their specialized knowledge would let them use drugs without the habit’s becoming dangerous, but almost always they were wrong. Noah Townsend’s words, “… never let things get away from me … know too much to ever lose control … I know where and when to stop …” seemed a pathetic echo of what Andrew read.

  The point was made that doctors became “successful addicts,” undetected for long periods, because of the ease with which they could obtain drugs. How well Andrew knew it! It was something he had discussed with Celia—the fact that physicians could get free supplies of any drug, virtually in unlimited quantity, merely by asking a detail man from the company concerned.

  In a way he was ashamed of, yet mentally justified as necessary, Andrew managed to inspect the cupboard in Noah Townsend’s office where drug supplies were kept. He did it at a time when Townsend was at the hospital, making grand rounds.

  The cupboard should have been locked, but it wasn’t. In it, piled high and occupying all available space, was an astounding collection of drugs in manufacturers’ containers, including narcotics of which there was a large supply. Andrew recognized some which Townsend had named.

  Andrew kept some drugs in his own office, samples of those he prescribed regularly, which he sometimes handed out to patients who he knew were in financial need. But compared with what was here, his own supply was trifling. Nor, for safety reasons, did Andrew ever accumulate narcotics. He whistled softly in amazement. How could Noah be so careless? How had he kept his secret for so long? How did he take the drugs he did and keep control? There seemed no simple answers.

  Something else shocked Andrew. He discovered from his researches that no overall program existed either to help doctors in trouble through excessive drug taking, or to protect their patients. The medical profession ignored the problem when it could; when it couldn’t, it covered it up by secrecy and closing ranks. No doctor, it seemed, ever reported another doctor for drug addiction. As for a drug-addicted physician losing his license to practice, Andrew couldn’t find a record of its happening.

  And yet the question haunted him: What about Noah Townsend’s patients who, in a way, were also Andrew’s because of the shared practice, with each doctor sometimes substituting for the other? Were those patients now at risk? While Townsend seemed normal in his behavior, and while he had made no mistakes medically so far as Andrew knew, would that condition continue? Could it be relied on? Would Noah someday, because of drugs, misdiagnose or fail to see an important symptom he should have caught? And what of his even larger responsibility as chief of medicine at St. Bede’s?

  The more Andrew thought, the more the questions multiplied, the more elusive were any answers.

  In the end he confided in Celia.

  It was early evening, a few days before Christmas. Celia and Andrew were at home and, with Lisa’s excited help, had been decorating their tree. It was Lisa’s first awareness of “Kissmus,” as she called it; all three were loving the experience. Eventually, with his daughter almost asleep from excitement and fatigue, Andrew gently carried her to bed. Afterward he stopped briefly in the adjoining bedroom where Bruce, the baby, was sleeping soundly in his crib.

  When Andrew returned to the living room, Celia had mixed a scotch and soda. “I made it a stiff one,” she said as she handed him the glass. “I think you need it.”

  As he looked at her inquiringly, she added, “Lisa was good for you tonight; you were more relaxed than I’ve seen you in weeks. But you’re still troubled. Aren’t you?”

  Surprised, he asked, “It shows that much?”

  “Darling, we’ve been married four years.”

  He said feelingly, “They’ve been the best four years of my life.” While he drank his scotch Andrew studied the Christmas tree and there was a silence while Celia waited. Then he said, “If it was that obvious, why didn’t you ask me what was wrong?”

  “I knew you’d tell me when you were ready.” Celia sipped a daiquiri she had made for herself. “Do you want to tell me? Now?”

  “Yes,” he said slowly. “Yes, I think I do.”

  “My God!” Celia said in a whisper when Andrew had finished. “Oh, my God!”

  “So you see,” he told her, “if I’ve been less than a barrel of laughs, there’s been good reason.”

  She came to him, putting her arms around him, her face against his, holding him close. “You poor, poor darling. What a burden you’ve been carrying. I had no idea. I’m so s
orry for you.”

  “More to the point—be sorry for Noah.”

  “Oh, I am. I really am. But I’m a woman, Andrew, and you’re the one who means most to me. I can’t, I won’t, see you go on this way.”

  He said sharply, “Then tell me what to do.”

  “I know what to do.” Celia released herself and turned to face him. “Andrew, you have to share this. You have to tell someone, and not just me.”

  “For instance—who?”

  “Isn’t it obvious? Someone at the hospital—someone with authority who can take some action, and help Noah too.”

  “Celia, I can’t. If I did, it would be talked about, brought out in the open … Noah would be disgraced. He’d be removed as chief of medicine, God knows what would happen about his license, and either way it would break him. I cannot, simply cannot, do that.”

  “Then what’s the alternative?”

  He said glumly, “I wish I knew.”

  “I want to help you,” Celia said. “I really do, and I have an idea.”

  “I hope it’s better than the last one.”

  “I’m not sure the last was wrong. But if you won’t talk about Noah Townsend specifically, why not talk to someone in the abstract. Sound them out. Discuss the subject generally. Find out how other people at the hospital feel.”

  “Do you have anyone in mind?”

  “Why not the administrator?”

  “Len Sweeting? I’m not sure.” Andrew took a turn around the room, considering, then stopped beside the Christmas tree. “Well, at least it’s an idea. Thanks. Let me think about it.”

  “I trust that you and Celia had a good Christmas,” Leonard Sweeting said.

  “Yes,” Andrew assured him, “we did.”

  They were in the hospital administrator’s office with the door closed. Sweeting was behind his desk, Andrew in a chair facing it.

  The administrator was a tall, lanky ex-lawyer who might have been a basketball player but instead had the unlikely hobby of pitching horseshoes, at which he had won several championships. He sometimes said the championships had been easier than getting doctors to agree about anything. He had switched from law to hospital work in his twenties and now, in his late forties, seemed to know as much about medicine as many physicians. Andrew had come to know Len Sweeting well since their joint involvement in the Lotromycin incident four years earlier, and on the whole respected him.

  The administrator had thick, bushy eyebrows which moved up and down like vibrating brushes every time he spoke. They moved now as Sweeting said briskly, “You said you had a problem, Andrew. Something you need advice about.”

  “Actually it’s a physician friend of mine in Florida who has the problem,” Andrew lied. “He’s on staff at a hospital down there and has uncovered something he doesn’t know how to deal with. My friend asked me to find out how we might handle the same situation here.”

  “What kind of situation?”

  “It has to do with drugs.” Briefly Andrew sketched out a mythical situation paralleling his own real one, though being careful not to make the comparison too close.

  As he spoke he was aware of a wariness in Sweeting’s eyes, the earlier friendliness evaporating. The administrator’s heavy eyebrows merged into a frown. At the end he pointedly stood up.

  “Andrew, I have enough problems here without taking on one from another hospital. But my advice is to tell your friend to be very, very cautious. That’s dangerous ground he’s treading on, especially in making an accusation against another doctor. Now, if you’ll excuse me …”

  He knew. With a flash of intuition Andrew realized that Len Sweeting knew precisely what he had been talking about, and whom. The Florida-friend gambit had not fooled Sweeting for an instant. God knows how, Andrew thought, but he’s known for longer than I have. And the administrator wanted no part of it. All he wanted, quite clearly at this moment, was to get Andrew out of his office.

  Something else. If Sweeting knew, then others in the hospital must know too. Almost certainly that meant fellow physicians, some of them a great deal senior to Andrew. And they were doing nothing either.

  Andrew stood up to go, feeling naïve and foolish. Len Sweeting came with him to the door, his friendliness returned, his arm around the younger man’s shoulders.

  “Sorry to have to hurry you away like this, but I have important visitors due—big donors to hospitals who we hope will give us several million dollars. As you’re aware, we really need that kind of money. By the way, your boss will be joining us. Noah is a tremendous help with fund-raising. Seems to know everybody, and everybody likes him. There are times I wonder how this hospital could continue functioning without our Dr. Townsend.”

  So there it was. The message, plain and unequivocal: Lay off Noah Townsend. Because of Noah’s connections and moneyed friends, he was too valuable to St. Bede’s for any scandal to intrude. Let’s cover it up, fellas; maybe if we pretend the problem isn’t there, it will go away.

  And of course, if Andrew attempted to repeat what Sweeting had just conveyed to him, the administrator would either deny the conversation had taken place or claim his remarks were misinterpreted.

  In the end, which was later the same day, Andrew decided he could only do what everyone else was doing—nothing. He resolved, though, that from now on and as best he could, he would watch his senior colleague closely and try to ensure that Noah’s medical practice or his patients did not suffer.

  When Andrew told Celia about the chain of events and what he had decided she looked at him strangely. “It’s your decision and I can understand why you made it. All the same, it may be something you’ll regret.”

  10

  Dr. Vincent Lord, director of research for Felding-Roth Pharmaceuticals, Inc., was a mixed-up—an unkind person might say “messed-up”—personality. A scientific colleague had observed wryly, “Vince behaves as if his psyche is whirling in a centrifuge, and he’s not sure how it will come out—or how he wants it to.”

  That such an assessment should be made at all was in itself paradoxical. At the relatively young age of thirty-six, Dr. Lord had reached a plateau of success which many dream of but few attain. But the fact that it was a plateau, or seemed to be, kept him worrying and wondering about how he got there and whether anything significant lay beyond it.

  What might also be said of Dr. Lord was that if there had not been disappointments in his life, he would have invented them. Expressed another way: Some of his disappointments were more illusory than real.

  One of them was that he had not received the respect he believed he deserved from the academic-scientific community, which was snobby about drug company scientists—regarding them generally, though often erroneously, as second-raters.

  Yet it had been Vincent Lord’s own personal, free choice, three years earlier, to move from an assistant professorship at the University of Illinois over to industry and Felding-Roth. However, strongly influencing that choice were Lord’s frustration and anger at the time—both directed at the university—the anger persisting even now to the point where it had become a permanent corroding bitterness.

  Along with the bitterness he sometimes asked himself: Had he been hasty and unwise in leaving academia? Would he have become a more respected international scientist had he stayed where he was, or at least moved to another university somewhere else?

  The story behind it all went back six years, to 1954.

  That was when Vincent Lord, a graduate student at U of I, became “Dr. Lord,” with a Ph.D. in organic chemistry. The doctorate was a good one. The university’s chemistry school at Champaign-Urbana was acknowledged as among the finest in the world, and Lord had proved himself a brilliant student.

  His appearance fitted the concept of a scholar. His face was thin, sensitive, delicately boned and, in a way, agreeable. Less agreeable was that he rarely smiled and often wore a worried frown. His vision was poor, perhaps from years of intense studying, and he wore rimless glasses through which dark
green eyes—Lord’s strongest feature—looked out with alertness mingled with suspicion. He was tall and lean, the last because food held no interest for him. He regarded meals as a waste of time and ate because his body required it; that was all. Women attuned to sensitive men found Vincent Lord attractive. Men seemed divided, either liking or detesting him.

  His field of expertise was steroids. This included male and female hormones—testosterone, estrogen, progesterone—which affect fertility, sexual aggressiveness and birth control, and during that period of the fifties when the Pill was just beginning to be used, the subject of steroids commanded wide scientific and commercial interest.

  After earning his Ph.D., and since his work on steroid synthesis was going well, it seemed logical for Dr. Lord to take a two-year postdoctoral fellowship, also at U of I.

  The university was cooperative, financing for a “postdoc” was obtained readily from a government agency, and the two years passed amid continued scientific success and only minor personal problems. The problems arose from Lord’s habit, close to an obsession, of looking over his shoulder mentally and asking himself: Did I do the right thing?

  He brooded: Had he made a mistake by remaining “in-house” at U of I? Should he have cut loose and gone to Europe? Would Europe have supplied a more rounded education? The questions—most of them unnecessary—multiplied persistently. They also made him moody and bad-tempered, a trait that would persist and lose him friends.

  And yet—another facet of the paradoxical prism which was Vincent Lord—he had a high opinion of his worth and work, an opinion that was wholly justified. Therefore it did not surprise him when, at the end of his two-year “postdoc,” the University of Illinois offered him a post as assistant professor. He accepted. Again he remained “in-house.” Again, as time went by, he brooded over that latest decision, repeating the torture of his earlier questions.