Strong Medicine (14 page)

Both their li~es had been made easier several months before by the advent

of a young Englishwoman, Winnie August, who now lived in and took care

of the children during their parents' absence. Andrew had found her

through an agency that advertised in medical journals. She was nineteen,

had previously worked as a shop assistant in London and, as Winnie

herself put it, she "wanted to

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lave a workin' 'oliday findin' out what you Yanks are like, then maybe

spend a couple o' years down under with the Aussies." She was cheerful,

quick and, to Andrew's great joy, whipped up breakfast each morning with

lightning speed. "Comes o' practice. Did it for me mum at 'ome," she told

him when he complimented her. Winnie also liked children and Lisa adored

her. Andrew and Celia hoped that Winnie's departure for Australia would

be long delayed.

One other event that came to Celia's attention happened near the end of

1960. The German drug Thalidomide-to be known in the U.S. and Canada as

Kevadon-was submitted to the FDA for marketing approval. According to

drug industry trade magazines, the Merrell Company, which now had North

American rights, had large-scale plans for Thalidomide-Kevadon, believing

the drug would be a huge seller, as it was continuing to be in Europe.

The company was pressing FDA for swift approval. Meanwhile samples of the

drug--officially for "investigative use," though in fact, without

restriction -were being distributed to over a thousand physicians by

enthusiastic Merrell detail men.

The news reminded Celia of her conversation with Sam Hawthorne eight

months earlier when he had reported resentment within Felding-Roth

because, at Celia's suggestion, Thalidomide had been tested only on old

people, then rejected. She wondered briefly if the resentment still

remained, then dismissed the subject as unimportant.

She had other business concerns.

Following Bruce's birth Celia returned to work more quickly than she had

after Lisa was born and was back at Felding-Roth by mid-December. One

reason: it was a busy time in Sales Training. The company was expanding

and a hundred more detail men were being taken on-plus, at Celia's

urging, some detail women, though only a half dozen. Also contributing

to her decision was an infectious sense of national excitement. In

November John F. Kennedy had been elected president and it seemed-from

the graceful rhetoric at least-as if a new era, stimulating and creative,

had begun.

"I want to be part of it all," Celia confided to Andrew. "People are

talking about 'a new beginning' and 'history in the making' and saying

it's a time to be young and in charge of something. Going back to work

means being involved."

"Uh-huh," Andrew had said, almost indifferently, which was unusual. Then,

as if realizing it, he added, "It's okay with me." But

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Andrew's mind was not really on Celia's endeavors; he was preoccupied with

a problem of his own.

The problem concerned Dr. Noah Townsend, Andrew's senior partner and the

respected chief of medicine at St. Bede's Hospital. Andrew had discovered

something about Noah which, ugly and unpleasant, brought into question

the older man's competence to practice medicine.

Dr. Townsend was a drug addict.

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Noah Townsend, now fifty-eight, had for many years appeared to represent

everything a seasoned, experienced physician should be. He was

conscientious, treating all who came to him, whether wealthy or poor, with

equal concern. His appearance was distinguished; in manner he had always

been courtly and dignified. As a result Dr. Townsend had a solid practice

with patients who liked him and were loyal-with good reason, since he

served them well. His diagnostic skills were regarded as remarkable.

Townsend's wife, Hilda, once told Andrew, "I've stood with Noah at a party

and he's looked across the room at a complete stranger and told me

quietly, 'That man is very ill and doesn't know it,' or another time,

'That woman over there-I don't know her name, but she's going to die in

six months.' And he's always been right. Always."

Townsend's patients felt much the same way. Some who exchanged anecdotes

about his accurate diagnoses referred to him as "the witch doctor." One

even brought back from Africa, as a gift, a witch doctor's mask which

Townsend proudly hung on his office wall.

Andrew, too, respected the older doctor's abilities. As well, there had

grown up between the two a genuine and warm affection, not least on

Andrew's part because Townsend had, in all ways, treated his much younger

colleague generously.

Contributing to Andrew's respect was the fact that Noah Townsend stayed

up-to-date medically through systematic reading, some-

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thing many physicians of his age neglected. Yet Andrew had also noticed,

over recent months, a certain vagueness at times on Townsend's part, and

occasional slurred speech. Then there had been those incidents earlier in

the year of Noah's apparently bizarre behavior. The combination of

symptoms made Andrew uneasy, though he continued to rationalize that

stress and tiredness could be their cause, since both doctors had been

working hard, with heavy patient loads.

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

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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

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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