Arthur Hailey - Strong Medicine

"Uh-huh," Andrew had said, almost indifferently, which was unusual. Then, as if realizing it, he added, "It's okay with me.”

But 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.

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 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 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.”