Strong Medicine (24 page)

changes were Townsend's own idea or the result of a quiet suggestion,

Andrew never found out. Also, from then on, Townsend led a less active

social fife, staying at home more than in the past. And at the office he

eased up on his patient load, mostly referring new patients to Andrew and

a new young doctor, Oscar Aarons, who had joined their practice.

From time to time Andrew still worried about Noah and patients, but because

there seemed no major problem, Andrew hadas he saw it now-simply drifted

along, doing nothing, waiting for something to happen, yet nurturing a

wishful belief it never would.

Until this week.

The climax, when it came, arrived with shattering suddenness.

At first Andrew had only partial, disconnected information. But soon

afterward, because of his suspicions and inquiries, he was able to piece

events together in their proper sequence.

They began on Tuesday afternoon.

A twenty-nine-year-old man, Kurt Wyrazik, appeared in Dr. Townsend's office

complaining of a sore throat, nausea, persistent coughing and feeling

feverish. An examination showed his throat to be inflamed; temperature was

102 and respiration rapid. Through his stethoscope, Noah Townsend's

clinical notes revealed, he heard suppressed breath sounds, lung rales, and

a pleural friction rub. He

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diagnosed pneumonia and instructed Wyrazik to go to St. Bede's Hospital

where he would be admitted immediately and where Townsend would see him

again, later in the day.

Wyrazik was not a new patient. He had been in the office several times

before, beginning three years earlier. On that first occasion he had also

had an inflamed throat and Townsend had given him, there and then, a shot

of penicillin.

In the days that followed the injection, Wyrazik's throat returned to

normal but he developed an itchy body rash. The rash indicated that he was

hypersensitive to penicillin; therefore that particular drug should not be

given him again because future side effects might be severe or even

catastrophic. Dr. Townsend made a prominent, red-starred note of this in

the patient's medical record.

Wyrazik had not, until that time, known about his allergy to penicillin.

On a second occasion, when Wyrazik arrived with a minor ailmtnt, Noah

Townsend was away and Andrew saw him. Reading the patient's file, Andrew

observed the warning about penicillin. At that point it did not apply,

since Andrew prescribed no medication.

That-about a year and a half earlier-was the last time Andrew saw VVyrazik

alive.

After Noah Townsend sent Wyrazik to St. Bede's, Wyrazik was installed in a

hospital room where there were three other patients. Soon afterward he was

given a normal workup by an intern who took a medical history. This was

routine. One of the questions the intern asked was, "Are you allergic to

anything?" Wyrazik replied, "Yes-to penicillin." The question and answer

were recorded on the patient's hospital chart.

Dr. Townsend kept his promise to see Wyrazik later at the hospital, but

before that he telephoned St. Bede's, instructing that the patient be given

the drug erythromycin. The intern complied with the order. Since, with most

patients, it was normal to use penicillin to treat pneumonia, it appeared

that Townsend had either read the allergy warning in his file, or had

remembered it-perhaps both.

That same day, when he visited Wyrazik in the hospital, Townsend would

have-or should have-read the intern's notes, thus receiving a further

reminder about the penicillin allergy.

The patient's own background had some relevance to what happened, or failed

to happen, later.

Kurt Wyrazik was a mild, unobtrusive person, unmarried and without close

friends. Employed as a shipping clerk, he lived alone

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and was in every sense a "loner." No one visited him while he was in the

hospital. Wyrazik was American-born; his parents had been Polish immigrants.

His mother was dead. His father lived in a small town in Kansas with Kurt's

older sister, also unmarried. The two were the only people in the world with

whom Kurt Wyrazik had close ties. However, he did not inform them that he

was ill and in St. Bede's.

Thus the situation remained until the second day of Wyrazik's stay in the

hospital.

On the evening of that second day, around 8 P.m., he was seen again by Dr.

Townsend. At this point also, Andrew had some indirect connection with the

case.

Noah Townsend, of late, had taken to visiting his hospital patients at

unorthodox hours. As Andrew and others reasoned afterward, he may have done

so to avoid meeting medical colleagues in the daytime, or it may have been

his general disorientation due to drugs. It so happened that Andrew was

also at St. Bede's that evening, dealing with an emergency for which he had

been called from home. Andrew was about to leave the hospital as Townsend

arrived, and they spoke briefly.

Andrew knew at once from Noah Townsend's demeanor and speech that the older

physician was under the influence of drugs and had probably taken some

quite recently. Andrew hesitated but, since he had been living with the

situation for so long, reasoned that nothing harmful would happen;

therefore he did nothing. Later Andrew would blame himself bitterly for

that omission.

As Andrew drove away, Townsend took an elevator to the medical floor where

he saw several patients. The young man, Wyrazik, was the last.

What went on in Townsend's mind at that point could only be guessed at.

What was known was that Wyrazik's condition, while not critical, had

worsened slightly, with his temperature higher and breathing difficult. It

seemed likely that Townsend, in his befuddled state, decided the earlier

medication he had prescribed was not working and should be changed. He

wrote out new orders and, leaving Wyrazik, delivered them personally to the

nursing station.

The new orders were for six hundred thousand units of penicillin every six

hours, injected intramuscularly, with the first injection to be given at

once.

Because of the absence, through illness, of a senior nurse, the night nurse

on duty was junior and new. She was also busy. Seeing

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nothing unusual in Dr. Townsend's order, she carried it out promptly. She

had not seen, nor did she read then, the earlier notes in the patient's

chart; hence she was unaware of the warning about penicillin allergy.

Wyrazik himself, when the nurse reached him, was both feverish and

sleepy. He did not ask what was being injected into him, nor did the

nurse volunteer the information. Immediately after giving the injection

the nurse left Wyrazik's room.

What happened next had to be partly conjecture; the other part was based

on a report from another patient in the room.

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 fi~ce, 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 -mercifi illy, 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 bead 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

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allergy. It was also possible that, with some extraordinary luck, the two

incriminating items-tbe 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

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